1 Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Saint Denis, France.
2 SAMU 974, Centre Hospitalier Universitaire Felix Guyon, Saint Denis, France.
Eur Heart J Acute Cardiovasc Care. 2018 Jun;7(4):371-378. doi: 10.1177/2048872617719652. Epub 2017 Jun 30.
There is no heart transplantation centre on the French overseas territory of Reunion Island (distance of 10,000 km). The aim of this study was to describe the characteristics of cardiogenic shock adult patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) who were transferred from Reunion Island to mainland France for emergency heart transplantation.
This retrospective observational study was conducted between 2005 and 2015. The characteristics and outcome of cardiogenic shock patients on VA-ECMO were compared with those of cardiogenic shock patients not on VA-ECMO.
Thirty-three cardiogenic shock adult patients were transferred from Reunion Island to Paris for emergency heart transplantation. Among them, 19 (57.6%) needed mechanical circulatory support in the form of VA-ECMO. Median age was 51 (33-57) years and 46% of the patients had ischaemic heart disease. Patients on VA-ECMO presented higher Sequential Organ Failure Assessment score ( p = 0.03). No death occurred during the medical transfer by long flight, while severe complications occurred in 10 patients (30.3%). Incidence of thromboembolic events, severe infectious complications and major haemorrhages was higher in the group of patients on VA-ECMO than in the group of patients not on VA-ECMO ( p <0.01). Seven patients from the VA-ECMO group (36.8%) and six patients from the non-VA-ECMO group (42.9%, p=0.7) underwent heart transplantation after a median delay of 10 (4-29) days on the emergency waiting list. After heart transplantation, one-year survival rates were 85.7% for patients on VA-ECMO and 83.3% for patients not on VA-ECMO ( p=0.91).
This study suggests the feasibility of very long-distance medical evacuation of cardiogenic shock patients on VA-ECMO for emergency heart transplantation, with acceptable long-term results.
法国海外领地留尼汪岛上没有心脏移植中心（距离 10000 公里）。本研究旨在描述从留尼汪岛转至法国大陆接受紧急心脏移植的因心源性休克使用静脉-动脉体外膜肺氧合（VA-ECMO）治疗的成年患者的特征。
这是一项回顾性观察性研究，于 2005 年至 2015 年进行。比较了因心源性休克使用 VA-ECMO 与未使用 VA-ECMO 治疗的患者的特征和结局。
33 例因心源性休克的成年患者从留尼汪岛转至巴黎接受紧急心脏移植。其中 19 例（57.6%）需要 VA-ECMO 形式的机械循环支持。中位年龄为 51（33-57）岁，46%的患者患有缺血性心脏病。使用 VA-ECMO 的患者序贯器官衰竭评估（SOFA）评分更高（p=0.03）。在长途飞行的医疗转移过程中无死亡发生，但 10 例（30.3%）患者发生严重并发症。VA-ECMO 组血栓栓塞事件、严重感染并发症和大出血的发生率高于非 VA-ECMO 组（p<0.01）。VA-ECMO 组 7 例（36.8%）和非 VA-ECMO 组 6 例（42.9%，p=0.7）患者在急诊等待名单上等待 10（4-29）天后接受心脏移植。心脏移植后，VA-ECMO 组患者 1 年生存率为 85.7%，非 VA-ECMO 组患者为 83.3%（p=0.91）。
本研究表明，因心源性休克使用 VA-ECMO 治疗的患者可进行远距离医疗后送进行紧急心脏移植，且长期结果可接受。
