Citation

Gariboldi V, Grisoli D, Tarmiz A, Jaussaud N, Chalvignac V, Kerbaul F, Collart F. Ann. Thorac. Surg. 2010; 90(5): 1548-1552.

Copyright

(Copyright © 2010, Society of Thoracic Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.athoracsur.2010.06.091

PMID

unavailable

Abstract

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective technique to provide emergency mechanical circulatory or respiratory assistance in critically ill patients. A Mobile Remote Cardiac Assist unit was created to implant ECMO in patients from outside our institution and bring them back in our intensive care unit for follow-up when stabilized. This study was undertaken to evaluate the feasibility and the preliminary results of this procedure.

METHODS: Between March 2006 and June 2008, 38 consecutive patients with acute cardiac or respiratory failure were implanted with percutaneous ECMO. The logistic concerns, indications, complications, and outcomes of these patients were analyzed.

RESULTS: There were no logistic or technical problems during the round trip or ECMO implantation. Mean distance from our intensive care unit was 68 km (1 to 230). Maximal time limit between the phone call and implantation was 90 minutes. The indications were fulminant myocarditis, pharmacologic suicide attempt, acute myocardial infarction, postpartum cardiopathy, end-stage cardiomyopathy, with left ventricular ejection fraction of 0.19 ± 0.05 (n = 32), or acute respiratory distress syndrome without cardiac failure (n = 6). Patients received a percutaneous venoarterial femoral ECMO with immediate reperfusion of the limb or venovenous ECMO for isolated lung failure. Seventeen patients (45%) were successfully weaned from ECMO after 9.4 ± 8.7 days. Four patients (11%) were transplanted. One patient was switched to a left ventricular assist device and was then successfully transplanted. Twenty-one patients (55%) survived to hospital discharge.

CONCLUSIONS: The Mobile Cardiac Assist unit allowed emergency implantation of ECMO support in remote institutions without any logistic or technical problems. © 2010 The Society of Thoracic Surgeons.

Language: en

Keywords

Humans; adolescent; Adult; Female; Male; Middle Aged; adult; human; Adolescent; female; male; Retrospective Studies; multiple organ failure; Extracorporeal Membrane Oxygenation; liver failure; suicide attempt; heart failure; article; retrospective study; clinical article; priority journal; middle aged; intensive care unit; cardiomyopathy; sepsis; hospital discharge; acute kidney failure; acute heart infarction; neurologic disease; heart disease; respiratory failure; heart surgery; adult respiratory distress syndrome; graft survival; myocarditis; hemolysis; continuous hemodialysis; outcome assessment; heart left ventricle ejection fraction; feasibility study; Shock, Cardiogenic; acute heart failure; Heart Failure; extracorporeal oxygenation; Cardiac Surgical Procedures; computer assisted surgery; isolated lung; limb ischemia; reperfusion