Guenther Sabina P W, Buchholz Stefan, Born Frank, Brunner Stefan, Schramm René, Hoechter Dominik J, von Dossow Vera, Pichlmaier Maximilian, Hagl Christian, Khaladj Nawid
Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany.
Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany.
Air Med J. 2017 Nov-Dec;36(6):320-326. doi: 10.1016/j.amj.2017.06.007. Epub 2017 Aug 12.
Extracorporeal life support (ECLS) emerges as a salvage option in therapy refractory cardiogenic shock but is limited to highly specialized tertiary care centers. Critically ill patients are often too unstable for conventional transport. Mobile ECLS programs for remote implantation and subsequent air or ground-based transport for patient retrieval could solve this dilemma and make full-spectrum advanced cardiac care available to patients in remote hospitals in whom shock otherwise might be fatal.
From December 2012 to March 2016, 40 patients underwent venoarterial ECLS implantation in remote hospitals with subsequent transport to our center and were retrospectively analyzed. The mobile ECLS team was available 24/7, implantation was performed percutaneously bedside, and compact support systems designed for transport were used.
Twenty percent of the patients were female; the mean age was 55 ± 10 years, and the mean Interagency Registry for Mechanically Assisted Circulatory Support score was 1.3 ± 0.5. Patient retrieval was accomplished via ground-based (n = 29, 72.5%, mean distance = 27.9 ± 29.7 km [range, 5.6-107.1 km]) or air (n = 11, mean distance = 62.4 ± 27.2 km [range, 38.9-116.4 km]) transport. No ECLS-related complications occurred during transport. The ECLS system could be explanted in 65.0% (n = 26) of patients, and the 30-day survival rate was 52.5% (n = 21).
Remote ECLS implantation and interfacility transport on ECLS are feasible and effective. Interdisciplinary teams and full-spectrum cardiac care are essential to achieve optimal outcomes. Rapid-response ECLS networks have the potential to substantially increase the survival of cardiogenic shock patients.
体外生命支持（ECLS）已成为治疗难治性心源性休克的一种挽救手段，但仅限于高度专业化的三级医疗中心。重症患者通常病情过于不稳定，无法进行传统转运。用于远程植入并随后通过空中或地面转运接回患者的移动ECLS项目可以解决这一难题，并为偏远医院中休克否则可能致命的患者提供全方位的高级心脏护理。
2012年12月至2016年3月，40例患者在偏远医院接受了静脉-动脉ECLS植入，随后转运至我们中心，并进行回顾性分析。移动ECLS团队随时待命，在床边经皮进行植入，并使用专为转运设计的紧凑型支持系统。
20%的患者为女性；平均年龄为55±10岁，平均机械辅助循环支持机构间注册评分（Interagency Registry for Mechanically Assisted Circulatory Support score）为1.3±0.5。通过地面转运（n = 29，72.5%，平均距离 = 27.9±29.7 km [范围，5.6 - 107.1 km]）或空中转运（n = 11，平均距离 = 62.4±27.2 km [范围，38.9 - 116.4 km]）接回患者。转运期间未发生与ECLS相关的并发症。65.0%（n = 26）的患者可以撤除ECLS系统，30天生存率为52.5%（n = 21）。
远程ECLS植入及在ECLS支持下的机构间转运是可行且有效的。跨学科团队和全方位心脏护理对于实现最佳治疗效果至关重要。快速反应的ECLS网络有可能显著提高心源性休克患者的生存率。
