Gerard David, Raffin Hervé, Lebreton Guillaume
Medic'Air International, Bagnolet, France.
Aerosp Med Hum Perform. 2017 Apr 1;88(4):431-433. doi: 10.3357/AMHP.4470.2017.
Extra corporeal life support (ECLS) is presently first line therapy for refractory cardiogenic shock. Mobile circulatory support teams implant ECLS or extra corporeal membrane oxygenation (ECMO) in patients in the hospital without circulatory support. These patients are then transported to specialized centers. Here we report a case of sending a mobile circulatory support team abroad, followed by air ambulance evacuation, which, to our knowledge, has never been used as part of medical assistance abroad.
In June, during a holiday in Turkey, a 56-yr-old woman complained about chest pain. She had a cardiac arrest and was resuscitated with no no-flow time in the local hospital. ECG showed ST segment elevation. Medic'Air International medical assistance (Paris, France) contacted the hospital, which was not equipped with coronarography or cardiac ultrasound and the local treating doctor refused transfer of the patient to another facility. A medical team completed by a cardiothoracic surgeon and a perfusionist went from Paris to the patient's bedside by air ambulance. They implemented the ECLS and successfully repatriated the patient to her home country (Belgium). The patient's condition improved, she neurologically improved, and returned home on the 14th day.
Possible indications for ECLS repatriations firstly take into account recognized ECLS indications and case-by-case discussions on the evaluation of inadequacy of the health facilities and risk-benefit balance. In international medical assistance, this case's description is an example of repatriation for patients who previously could not be transferred due to high risk of such intervention.Gerard D, Raffin H, Lebreton G. Aeromedical evacuation using extra corporeal life support after resuscitated cardiac arrest. Aerosp Med Hum Perform. 2017; 88(4):431-433.
体外生命支持（ECLS）目前是难治性心源性休克的一线治疗方法。移动循环支持团队在没有循环支持的医院为患者植入ECLS或体外膜肺氧合（ECMO）。然后将这些患者转运至专业中心。在此，我们报告一例派遣移动循环支持团队出国，随后通过空中救护车进行撤离的病例，据我们所知，这从未被用作国外医疗援助的一部分。
6月，一名56岁女性在土耳其度假期间诉说胸痛。她发生心脏骤停，在当地医院复苏成功且无无血流时间。心电图显示ST段抬高。国际医疗援助组织Medic'Air（法国巴黎）联系了该医院，该医院未配备冠状动脉造影或心脏超声设备，当地主治医生拒绝将患者转至另一机构。一个由心胸外科医生和灌注师组成的医疗团队乘空中救护车从巴黎赶赴患者床边。他们实施了ECLS，并成功将患者遣返回其祖国（比利时）。患者病情改善，神经功能好转，并于第14天回国。
ECLS遣返的可能指征首先要考虑公认的ECLS指征，以及针对医疗机构不足评估和风险效益平衡的逐案讨论。在国际医疗援助中，本病例的描述是为以前因此类干预风险高而无法转运的患者进行遣返的一个例子。
杰拉德·D、拉芬·H、勒布雷顿·G。心脏骤停复苏后使用体外生命支持的航空医疗后送。航空航天医学与人类表现。2017；88（4）：431 - 433。
