Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock

• Published in: European journal of cardio-thoracic surgery 2011-09, Vol.40 (3), p.689-694
• Main Authors: Arlt, Matthias, Philipp, Alois, Voelkel, Sabine, Camboni, Daniele, Rupprecht, Leopold, Graf, Bernhard-Martin, Schmid, Christof, Hilker, Michael
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Emergencies; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Equipment Design; Extracorporeal Membrane Oxygenation - instrumentation; Extracorporeal Membrane Oxygenation - methods; Female; Hemodynamics - physiology; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Pneumology; Pulmonary Gas Exchange - physiology; Retrospective Studies; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.12.055

Abstract Objective: Cardiogenic shock is associated with mortality rates up to 70%, even if patients are treated with intensive care support or thrombolytic therapy. Early coronary revascularisation can be life-saving but it is oftentimes not available at the hospital to which the patient was initially taken. Up to now, transferring patients in a state of severe cardiogenic shock and/or cardiopulmonary resuscitation is mostly decided to be impossible. We report on the use of two newly developed minimised systems for hand-held-extracorporeal membrane oxygenation (ECMO) (ELS-System™ and CARDIOHELP™, both from MAQUET Cardiopulmonary AG, Germany), which we have used for rapid extracorporeal life support and interhospital transfer on Mini-ECMO. We characterise the emergency use, safety instructions and bridging function of these novel Mini-ECMO devices. Methods: Between June 2007 and August 2010, we administered percutaneous Mini-ECMO support to 21 adult cardiogenic shock patients. The main components of each Mini-ECMO system are a centrifugal pump and a membrane oxygenator. The systems can act independently from wall connection points, and are they are small enough to be attached nearby a patient's side during transport. Results: On ECMO, gas exchange improved significantly, vasopressor support could be significantly marked down and signs of shock disappeared in all patients. Emergency medical service was carried out in re-established blood-flow and oxygen delivery. The patients were bridged to coronary artery bypass grafting (CABG) (n = 6), ventricular assist device (n = 1) or pulmonary embolectomy (n = 1) or specialised intensive care (n = 13). Thirteen patients (62%) had completely recovered. Conclusions: The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients.