Refractory cardiac arrest in a rural area: mechanical chest compression during helicopter transport.
BACKGROUND
Out-of-hospital refractory cardiac arrest patients can be transported to a hospital for extracorporeal life support (ECLS), which can be either therapeutic or performed for organ donation. Early initiation is of vital importance and the main limitation when considering ECLS. This explains that all reported series of cardiac arrest patients referred for ECLS were urban ones. We report a series of rural out-of-hospital non-heart-beating patients transported by helicopter.


METHODS
This observational study was performed in two rural districts in France. Data on patients with pre-hospital criteria for ECLS who were transported to the hospital by helicopter, maintained by mechanical chest compression, were recorded over a 2-year period.


RESULTS
During the study period, 27 patients were referred for ECLS, of which 14 for therapeutic ECLS and 13 for organ preservation. The median transport distance was 37 km (25th and 75th percentiles: 31-58; range 25 to 94 km). Among the therapeutic ECLS patients, one survived to discharge from the hospital. Liver and kidneys were retrieved in another patient after brain death was ascertained. In the 13 patients referred for organ donation, four were excluded for medical reasons; 18 kidneys were retrieved in nine patients, of which six kidneys were successfully transplanted.


CONCLUSIONS
In this preliminary study, we report the feasibility and the interest of helicopter transport of refractory cardiac arrest patients maintained by mechanical chest compression. Patients with refractory cardiac arrest occurring in rural areas, even at distance from a referral centre, can be candidates for ECLS.
Services de Médecine d’Urgence et de Réanimation, Pôle Urgence Réanimation, SAMU 77, Melun, France.
K
K
Tazarourte
D
D
Sapir
F X
FX
Laborne
N
N
Briole
J Y
JY
Letarnec
A
A
Atchabahian
J F
JF
Cornu
M
M
Monchi
P
P
Jabre
X
X
Combes
D000328:Adult; D017732:Air Ambulances; D001926:Brain Death; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005602:France; D017408:Guidelines as Topic; D006336:Heart Massage / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010348:Patient Care Team; D012424:Rural Population; D014019:Tissue Donors; D014187:Transportation of Patients; D016896:Treatment Outcome