title: Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities.
abstract: OBJECTIVE
  We report the feasibility and outcomes of emergency extracorporeal membrane oxygenation (ECMO) implantation by a cardiac catheterisation team in patients in severe cardiogenic shock or refractory cardiac arrest in a hospital without cardiac surgical facilities.
  
  
  RESULTS
  This prospective cohort study involved 51 consecutive patients who had ECMO implantation (September 2006 - September 2010). Twenty-seven were in severe cardiogenic shock and 24 in refractory cardiac arrest (17 with out-of-hospital cardiac arrest; seven with in-hospital cardiac arrest). Implantations were done via a percutaneous femoral approach by a local interventional cardiologist team, and in collaboration with the nearest cardiac surgical institution. Patients' mean age was 51±15 years; 38 (74.5%) were men. Stable ECMO implantation was achieved in 26/27 (96.3%) patients in severe cardiogenic shock and in 18/24 (75.0%) patients in refractory cardiac arrest. In-hospital complications occurred in 23/27 cardiogenic shock patients; 13/27 were discharged alive. In patients with refractory cardiac arrest, complications occurred in 20/24; 21/24 were disconnected from ECMO because of brain death or multiorgan failure occurring ≤24 hours; one patient was discharged alive.
  
  
  CONCLUSIONS
  Emergency ECMO implantation by an interventional cardiologist in a hospital without cardiac surgical facilities is feasible, with a failure rate concordant with the literature.
authors: Cardiology Department, Annecy Hospital, 1 avenue de l'Hopital, Metz-Tessy, France. loic.belle@wanadoo.fr
authors: Loic
authors: L
authors: Belle
authors: Lionel
authors: L
authors: Mangin
authors: Henry
authors: H
authors: Bonnet
authors: Stephane
authors: S
authors: Fol
authors: Charles
authors: C
authors: Santré
authors: Laurence
authors: L
authors: Delavenat
authors: Dominique
authors: D
authors: Savary
authors: David
authors: D
authors: Bougon
authors: Emmanuelle
authors: E
authors: Vialle
authors: Antoine
authors: A
authors: Dompnier
authors: Emmanuel
authors: E
authors: Desjoyaux
authors: Dominique
authors: D
authors: Blin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D013903:Thoracic Surgery