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, PaO 2 <50 mmHg with FiO 2 >0.6 for >12 hours, PEEP >5 cmH 20, 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 2O, p<0.01). No major clinical or technical complications were observed. Conclusions: ECMO effectively enabled high-risk ground transfer of severely hypoxic patients. © 2011 Wichtig Editore.

Isgro', S., Patroniti, N., Bombino, M., Marcolin, R., Zanella, A., Milan, M., et al. (2011). Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience. INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 34(11), 1052-1060 [10.5301/ijao.5000011].

Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience

ISGRO', STEFANO;PATRONITI, NICOLO' ANTONINO;ZANELLA, ALBERTO;FOTI, GIUSEPPE;PESENTI, ANTONIO MARIA
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, PaO 2 <50 mmHg with FiO 2 >0.6 for >12 hours, PEEP >5 cmH 20, 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 2O, p<0.01). No major clinical or technical complications were observed. Conclusions: ECMO effectively enabled high-risk ground transfer of severely hypoxic patients. © 2011 Wichtig Editore.
Articolo in rivista - Articolo scientifico
Scientifica
Risk Assessment; Referral and Consultation; Treatment Outcome; Male; Retrospective Studies; Program Evaluation; Time Factors; Middle Aged; Female; Lung; Child, Preschool; Risk Factors; Italy; Equipment Design; Anoxia; Extracorporeal Membrane Oxygenation; Hospitals, General; Humans; Ambulances; Respiratory Distress Syndrome, Adult; Aged; Adult; Severity of Illness Index; Patient Transfer
English
Isgro', S., Patroniti, N., Bombino, M., Marcolin, R., Zanella, A., Milan, M., et al. (2011). Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience. INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 34(11), 1052-1060 [10.5301/ijao.5000011].
Isgro', S; Patroniti, N; Bombino, M; Marcolin, R; Zanella, A; Milan, M; Foti, G; Pesenti, A
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/29354
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