Mobile extracorporeal membrane oxygenation unit expands cardiac assist surgical programs

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is an effective technique to provide emergency mechanical circulatory or respiratory assistance in critically ill patients. A Mobile Remote Cardiac Assist unit was created to implant ECMO in patients from outside our institution and bring them back in our intensive care unit for follow-up when stabilized. This study was undertaken to evaluate the feasibility and the preliminary results of this procedure.

Methods: Between March 2006 and June 2008, 38 consecutive patients with acute cardiac or respiratory failure were implanted with percutaneous ECMO. The logistic concerns, indications, complications, and outcomes of these patients were analyzed.

Results: There were no logistic or technical problems during the round trip or ECMO implantation. Mean distance from our intensive care unit was 68 km (1 to 230). Maximal time limit between the phone call and implantation was 90 minutes. The indications were fulminant myocarditis, pharmacologic suicide attempt, acute myocardial infarction, postpartum cardiopathy, end-stage cardiomyopathy, with left ventricular ejection fraction of 0.19 ± 0.05 (n = 32), or acute respiratory distress syndrome without cardiac failure (n = 6). Patients received a percutaneous venoarterial femoral ECMO with immediate reperfusion of the limb or venovenous ECMO for isolated lung failure. Seventeen patients (45%) were successfully weaned from ECMO after 9.4 ± 8.7 days. Four patients (11%) were transplanted. One patient was switched to a left ventricular assist device and was then successfully transplanted. Twenty-one patients (55%) survived to hospital discharge.

Conclusions: The Mobile Cardiac Assist unit allowed emergency implantation of ECMO support in remote institutions without any logistic or technical problems.