Long distance transport of cardiac patients in extremis: the mobile intensive care (MOBI) concept.

Critically ill cardiac patients may require transport to distant centers. Their clinical demands often exceed the capabilities of land or air ambulance services. To provide this service, a new, safe, and cost-effective concept for transport of the critically ill was developed. A mobile intensive care unit system (MOBI) was developed with support capabilities of an intra-aortic balloon pump, defibrillator, ventilator, pulse oximeter, multiple infusion pumps, and pressure and EKG monitoring. Eleven patients in cardiogenic shock, all with multidrip inotropic therapy, eight requiring intra-aortic balloon pump, three of whom were on the ventilator, were transported. Six patients were transported in aircraft, with the longest transport over 2,000 mi. Five patients were transported by ground ambulance. All patients survived the transport: no complications were attributed to the transport process. The system is cost effective since slight modification is required in regular ambulance or chartered aircraft to provide the highest level of care.