Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Interhospital Transport System for Critically Ill Patients: Mobile Extracorporeal Membrane Oxygenation without a Ventilator

  • Yeo, Hye Ju (Department of Pulmonology and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Cho, Woo Hyun (Department of Pulmonology and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Park, Jong Myung (Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Kim, Dohyung (Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital)
  • Received : 2016.02.02
  • Accepted : 2016.03.23
  • Published : 2017.02.05
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been successfully used as a method for the interhospital transportation of critically ill patients. In South Korea, a well-established ECMO interhospital transport system is lacking due to limited resources. We developed a simplified ECMO transport system without mechanical ventilation for use by public emergency medical services. Methods: Eighteen patients utilized our ECMO transport system from December 2011 to September 2015. We retrospectively analyzed the indications for ECMO, the patient status during transport, and the patient outcomes. Results: All transport was conducted on the ground by ambulance. The distances covered ranged from 26 to 408 km (mean, $65.9{\pm}88.1km$) and the average transport time was $56.1{\pm}57.3minutes$ (range, 30 to 280 minutes). All patients were transported without adverse events. After transport, 4 patients (22.2%) underwent lung transplantation because of interstitial lung disease. Eight patients who had severe acute respiratory distress syndrome showed recovery of heart and lung function after ECMO therapy. A total of 13 patients (70.6%) were successfully taken off ECMO, and 11 patients (61.1%) survived. Conclusion: Our ECMO transport system without mechanical ventilation can be considered a safe and useful method for interhospital transport and could be a good alternative option for ECMO transport in Korean hospitals with limited resources.

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References

  1. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. https://doi.org/10.1016/S0140-6736(09)61069-2
  2. Ciapetti M, Cianchi G, Zagli G, et al. Feasibility of inter-hospital transportation using extra-corporeal membrane oxygenation (ECMO) support of patients affected by severe swine-flu(H1N1)-related ARDS. Scand J Trauma Resusc Emerg Med 2011;19:32. https://doi.org/10.1186/1757-7241-19-32
  3. Lee SG, Son BS, Kang PJ, et al. The feasibility of extracorporeal membrane oxygenation support for inter-hospital transport and as a bridge to lung transplantation. Ann Thorac Cardiovasc Surg 2014;20:26-31. https://doi.org/10.5761/atcs.oa.12.00203
  4. Raghavendran K, Napolitano LM. ALI and ARDS: challenges and advances. Crit Care Clin 2011;27:xiii-xiv.
  5. Broman LM, Holzgraefe B, Palmer K, Frenckner B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care 2015;19:278. https://doi.org/10.1186/s13054-015-0994-6
  6. Bryner B, Cooley E, Copenhaver W, et al. Two decades' experience with interfacility transport on extracorporeal membrane oxygenation. Ann Thorac Surg 2014;98:1363-70. https://doi.org/10.1016/j.athoracsur.2014.06.025
  7. Kluge S, Braune SA, Engel M, et al. Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 2012;38:1632-9. https://doi.org/10.1007/s00134-012-2649-2
  8. Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 2012;185: 763-8. https://doi.org/10.1164/rccm.201109-1599OC
  9. Wiesner O, Hadem J, Sommer W, Kuhn C, Welte T, Hoeper MM. Extracorporeal membrane oxygenation in a nonintubated patient with acute respiratory distress syndrome. Eur Respir J 2012;40:1296-8. https://doi.org/10.1183/09031936.00076912

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