Fiorelli Francesca, Panoulas Vasileios, Riesgo Gil Fernando, Era Carl, Rosenberg Alexander
Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK.
Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK.
Eur Heart J Case Rep. 2024 Mar 21;8(5):ytae151. doi: 10.1093/ehjcr/ytae151. eCollection 2024 May.
The use of mechanical circulatory support (MCS) has markedly increased over the last decade, so have the inter-hospital transfers, with the aim of being able to offer advanced heart failure (AHF) therapies and centralizing patients to tertiary centres.
In this article, we present the first in Europe long-distance air transfer of a patient supported by veno-arterial extracorporeal membrane oxygenator and Impella (ECPELLA), as a bridge to successful heart transplant. In our case report, a foreign young patient with AHF due to familiar cardiomyopathy required multiple MCS devices to achieve cardiovascular stability. After appropriate planning and multidisciplinary discussion, the patient was transferred on MCS to his country of origin via a fixed-wing airplane, in order to be assessed for heart transplantation. During take-off, the Impella flows temporarily dropped and a suction alarm was displayed; however, this rectified without intervention, and the rest of the flight was uneventful. One month after transfer, the patient underwent successful heart transplantation and remained clinically stable during the 12-month follow-up.
Our experience links together the current challenges in the evolving AHF strategies and the increased need for inter-facility cooperation. Both these clinical and logistic challenges appear to lead to possible improved outcomes, after appropriate assessment, training, and accurate planning. Our experience provides useful information on feasibility of long-distance transport of patients supported by ECPELLA in Europe.
在过去十年中，机械循环支持（MCS）的使用显著增加，医院间转运的情况也是如此，目的是能够提供晚期心力衰竭（AHF）治疗并将患者集中到三级中心。
在本文中，我们介绍了欧洲首例由静脉-动脉体外膜肺氧合器和Impella（ECPELLA）支持的患者长途空中转运，作为成功心脏移植的桥梁。在我们的病例报告中，一名因家族性心肌病导致AHF的外国年轻患者需要多种MCS设备来实现心血管稳定。经过适当规划和多学科讨论后，该患者在MCS支持下通过固定翼飞机转运回其原籍国，以便进行心脏移植评估。起飞期间，Impella的流量暂时下降并显示抽吸警报；然而，未经干预此情况自行纠正，其余飞行过程平安无事。转运一个月后，患者接受了成功的心脏移植，在12个月的随访期间临床情况稳定。
我们的经验将不断发展的AHF策略中的当前挑战与机构间合作需求的增加联系在一起。经过适当评估、培训和准确规划后，这两个临床和后勤方面的挑战似乎都可能带来更好的结果。我们的经验为欧洲ECPELLA支持的患者长途转运的可行性提供了有用信息。
