Purpose: Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods: This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2<50 mmHg with FiO2>0.6 for >12 hours, PEEP >5 cmH20, Lung Injury Score (LIS) â¥3 or respiratory acidosis with pH<7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. Results: Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (meanÂ±SD, age 35.4Â±18.6, SOFA 8.4Â±3.7, Oxygenation Index 43.7Â±13.4) were transported to our institution (distance covered 102Â±114 km, global duration of transport 589Â±186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7Â±1 LÂ·min-1, gas flow 3.8Â±1.8 LÂ·min-1, and FiO21. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO2(75Â±23 vs. 53Â±9 mmHg, p<0.01) thus improving pH (7.28Â±0.13 vs. 7.39Â±0.05, p<0.01) and allowing a reduction in respiratory rate (35Â±14 vs. 10Â±4 breaths/min, p<0.01), minute ventilation (10.1Â±3.8 vs. 3.7Â±1.7 LÂ·min-1, p<0.01), and mean airway pressure (26Â±6.5 vs. 22Â±5 cmH2O, p<0.01). No major clinical or technical complications were observed. Conclusions: ECMO effectively enabled high-risk ground transfer of severely hypoxic patients. Â© 2011 Wichtig Editore.
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|Titolo:||Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: A 5-year experience|
|Data di pubblicazione:||2011|
|Appare nelle tipologie:||01.01 - Articolo su rivista|