Purpose: Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods: This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 <50 mmHg with FiO(2) >0.6 for >12 hours, PEEP >5 cmH 2 0, Lung Injury Score (LIS) >= 3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. Results: Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean +/- SD, age 35.4 +/- 18.6, SOFA 8.4 +/- 3.7, Oxygenation Index 43.7 +/- 13.4) were transported to our institution (distance covered 102 +/- 114 km, global duration of transport 589 +/- 186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7 +/- 1 L.min(-1), gas flow 3.8 +/- 1.8 L.min(-1), and FiO(2) 1. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO 2 (75 +/- 23 vs. 53 +/- 9 mmHg, p<0.01) thus improving pH (7.28 +/- 0.13 vs. 7.39 +/- 0.05, p<0.01) and allowing a reduction in respiratory rate (35 +/- 14 vs. 10 +/- 4 breaths/min, p<0.01), minute ventilation (10.1 +/- 3.8 vs. 3.7 +/- 1.7 L.min(-1), p<0.01), and mean airway pressure (26 +/- 6.5 vs. 22 +/- 5 cmH(2) O, p<0.01). No major clinical or technical complications were observed. Conclusions: ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.
Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: a 5-year experience / S. Isgrò, N. Patroniti, M. Bombino, R. Marcolin, A. Zanella, M. Milan, G. Foti, A. Pesenti. - In: INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS. - ISSN 0391-3988. - 34:11(2011), pp. 1052-1060. [10.5301/ijao.5000011]
Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: a 5-year experience
A. Zanella;A. Pesenti
2011
Abstract
Purpose: Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods: This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 <50 mmHg with FiO(2) >0.6 for >12 hours, PEEP >5 cmH 2 0, Lung Injury Score (LIS) >= 3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. Results: Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean +/- SD, age 35.4 +/- 18.6, SOFA 8.4 +/- 3.7, Oxygenation Index 43.7 +/- 13.4) were transported to our institution (distance covered 102 +/- 114 km, global duration of transport 589 +/- 186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7 +/- 1 L.min(-1), gas flow 3.8 +/- 1.8 L.min(-1), and FiO(2) 1. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO 2 (75 +/- 23 vs. 53 +/- 9 mmHg, p<0.01) thus improving pH (7.28 +/- 0.13 vs. 7.39 +/- 0.05, p<0.01) and allowing a reduction in respiratory rate (35 +/- 14 vs. 10 +/- 4 breaths/min, p<0.01), minute ventilation (10.1 +/- 3.8 vs. 3.7 +/- 1.7 L.min(-1), p<0.01), and mean airway pressure (26 +/- 6.5 vs. 22 +/- 5 cmH(2) O, p<0.01). No major clinical or technical complications were observed. Conclusions: ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.Pubblicazioni consigliate
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