Page 35 - ANZCP Gazette MAY 2014

ECMO SUPPORTED CPR
Alois Philipp ECCP, Thomas Mueller MD, Matthias Arlt MD, Dirk Lunz MD and Christof Schmid MD. University Hospital Regensburg, Germany, Franz Josef Strauss Alle 11, D-93053 Regensburg, Germany
We report on our experience since 2008 with extracorporeal life support (ECLS) in adult patients suffering from cardiogenic shock or cardiac arrest by providing an analysis of the prospectively collected data of the Regensburg ECMO registry.
Main results
245 patients were treated with ECLS. 152 (62%) did not undergo cardiac surgery prior to ECLS. In this group cannulation was performed in all cases percutaneously by Seldinger technique. Location of ECLS implantation was: Emergency room n=29, dept. of internal medicine n=29, cath.-lab. n=30, out of center n=34 (with consecutive air or ground transport) and various locations in the hospital n=30. The survival rate of patients without previous cardiac surgery was 38%.
93 patients were connected to an ECLS post cardiac surgery, in this group 60% could be weaned from ECLS. 10 patients
subsequently received a left ventricular assist device (LVAD). 32% survived to discharge.
Conclusions
Modern miniaturized ECLS devices provide vital gas transfer and circulation in patients suffering cardiogenic shock or cardiac arrest. Increasing importance of such devices in intensive care medicine and emergency room is to be expected.
References
1. M.Arlt,A.Philipp,S.Voekl,et.al.,“Out-of-hospitalextracorporeallifesupport for cardiac arrest—A case report” Resuscitation. 2011 Sep;82(9):1243-5.
2. HaneyaA,PhilippA.,DiezC.,et.al.,“A5-yearexperiencewithcardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest” Resuscitaion 2012 Nov;83(11):1331-7
PATIENT TRANSPORT ON ECLS
Matthias Arlt1 MD, Alois Philipp2 ECCP, Bernhard M. Graf3 MD, PhD, Christof Schmid2 MD, PhD and Michael Hilker2 MD, PhD
1Kerckhoff Heart and Lung Centre, Dept. of Anesthesiology and Intensive Care 2University Hospital Regensburg, Dept. of Cardiothoracic Surgery 3University Hospital Regensburg, Dept. of Anesthesiology
Research was carried out at University Hospital Regensburg, Germany
Dept. of Anesthesiology and Intensive Care
Kerckhoff Heart and Lung Centre, Benekestr. 2-8, D-61231 Bad Nauheim, Germany
Background
Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxia-dependent organ failure. Extracorporeal life support (ECLS) can be an option but is often not available in outlying facilities. We report on mobile ECLS support and patient transport on ECLS which has been facilitated by the development of miniaturised, hand-held ECLS systems.
Method:
In 2006 we started our ECLS transport program at the University Hospital Regensburg. An ECLS phone hotline was established and requests for ECLS in patients located in outlying medical facilities were handled using a standardised questionnaire providing inclusion and exclusion criterions.
Patients with severe lung failure but preserved cardiocirculatory function were provided with percutaneous veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO). Patients with refractory cardiac-, or cardiocirculatory failure were supported by percutaneous femoro-femoral veno-arterial ECLS (VA-ECLS).
Additional patient transfer was carried out by rescue helicopter or ground ambulance.
Findings:
199 Patients were provided with percutaneous ECLS. VV- ECMO was necessary in 73% of the patients, VA-ECLS was used in 27%. Hospital discharge in VV-ECMO patients was 72% and 55%in VA-ECLS patients.
Conclusion: Patient transport on ECLS is safe and effective. Proper patient selection is crucial and specialised interdisciplinary transport teams are necessary.
1. Arlt M., Philipp A., Zimmermann M.et.al. First experiences with a new miniaturised life support system for mobile percutaneous cardiopulmonary bypass. Resuscitation 2008;77:345-50
2. Arlt M., Philipp A., Zimmermann M., et. al. Emergency use of Extracorporeal Membrane Oxygenation in cardiopulmonary failure. Artif Organs 2009;33:696-703
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