title: Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program).
abstract: OBJECTIVE
  Temporary circulatory support with extracorporeal membrane oxygenation (ECMO) is often the only alternative for supporting patients with refractory cardiogenic shock (RCS). In practice, this strategy is limited to a small minority of patients hospitalized in tertiary-care centres with ECMO programs. The cardiac-RESCUE program was designed to test the feasibility of providing circulatory support distant from specialized ECMO centres, for RCS patients in remote locations.
  
  
  RESULTS
  From January 2005 to December 2009, hospitals without ECMO facilities throughout the Greater Paris area were invited to participate. One hundred and four RCS cases were assessed and 87 consecutively eligible patients (mean age 46 ± 15 years, 41% following cardiac arrest) had ECMO support instituted locally and were enrolled into the program. Local initiation of ECMO support allowed successful transfer to the tertiary-care centre in 75 patients. Of these, 32 patients survived to hospital discharge [overall survival rate 36.8%, 95% confidence interval (CI) 27.4-46.2]. Independent predictors for in-hospital mortality included initiation of ECMO during cardiopulmonary resuscitation [hazard ratio (HR) = 4.81, 95% CI 2.25-10.30, P < 0.001] and oligo-anuria (HR = 2.48, 95% CI 1.29-4.76, P = 0.006). After adjusting for other confounding factors, in-hospital mortality was not statistically different from that of 123 consecutive patients who received ECMO at our institution during the same period (odds ratio 1.48, 95% CI 0.72-3.00, P = 0.29).
  
  
  CONCLUSIONS
  Offering local ECMO support appears feasible in a majority of RCS patients hospitalized in remote hospitals. In this otherwise lethal situation, our pilot experience suggests that over one-third of such patients can survive to hospital discharge.
authors.affiliation: Department of Cardiovascular Surgery, Pitié-Salpêtrière University Hospital, Paris Curie University, Paris, France. sylvainbeurtheret@gmail.com
authors.forename: Sylvain
authors.initials: S
authors.lastname: Beurtheret
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.forename: Xavier
authors.initials: X
authors.lastname: Paoletti
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: David S
authors.initials: DS
authors.lastname: Celermajer
authors.forename: Philippe
authors.initials: P
authors.lastname: Léger
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D004638:Emergency Treatment / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010865:Pilot Projects; D012770:Shock, Cardiogenic / Q000628:therapy*; D061665:Time-to-Treatment; D014187:Transportation of Patients; D016896:Treatment Outcome