title: Clinical course and long-term outcome following venoarterial extracorporeal life support-facilitated interhospital transfer of patients with circulatory failure.
abstract: BACKGROUND
  Interhospital transfer of patients experiencing circulatory failure and shock has a significant risk of cardiovascular deterioration and death. Extracorporeal life support (ECLS) is a rescue tool for hemodynamic stabilization that makes patient transportation much safer.
  
  
  METHODS
  Demographic data, clinical course, and outcome data were reviewed for patients who underwent placement of a venoarterial ECLS in a remote hospital and were transported to our tertiary care facility.
  
  
  RESULTS
  68 patients were transported to our center with ECLS. The majority of these patients (79%) underwent cardiopulmonary resuscitation during or immediately prior to ECLS initiation. The mean patient age was 52 years, and 53 patients were male. The most common underlying diagnosis was acute coronary syndrome (60%). Overall, 23 patients underwent consecutive cardiosurgical procedures, including coronary artery bypass grafting in 12, and left ventricular assist device and biventricular assist device implantation in 11. The median duration of ECLS was 5 days. None of the patients died during transportation. Twelve of the surgically treated patients survived, as well as 21 patients with non-surgical treatment, which resulted in an overall survival of 33 patients (48.5%).
  
  
  CONCLUSIONS
  ECLS-facilitated patient transfer enables safe interhospital transfer of critically ill patients. In this study, a relevant percentage of patients were in need of a cardiosurgical intervention. The long-term survival rate of these patients supports the further use of this time-, cost- and personnel-demanding strategy.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. Electronic address: Simon.Schopka@klinik.uni-regensburg.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Schopka
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.affiliation: Department of Internal Medicine II, University Medical Center, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.affiliation: Emergency Unit, University Medical Center, Regensburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Anaesthesiology, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Arlt
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Anaesthesiology, University Medical Center, Regensburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lunz
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012308:Risk Management / Q000379:methods; D012769:Shock / Q000209:etiology / Q000628:therapy; D014187:Transportation of Patients / Q000379:methods
keywords: Cardiopulmonary resuscitation; Extracorporeal circulation; Heart arrest; Shock