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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Interhospital transfer of critically ill patients using portable extracorporeal circulatory systems: a single center experience

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  • Assad Haneya - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Michael von der Brelie - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Hendrik Igelmann - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Sabrina Wespa - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Christoph Schneider - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Thomas Ivers - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Bernd Panholzer - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Arne Kowalski - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Nils Haake - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland
  • Jochen Cremer - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurgie, Kiel, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch578

doi: 10.3205/15dgch578, urn:nbn:de:0183-15dgch5786

Published: April 24, 2015

© 2015 Haneya et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: Modern portable extracorporeal circulatory systems (ECCS) currently establish a place in the treatment of acute severe cardiopulmonary failure with presumed improved survival. Nevertheless, ECCS require a high degree of experience, so that a restriction to specialized centers is meaningful. The aim of this report is to describe our experiences of interhospital transfer using ECCS for critically ill patients.

Methods: From January 2009 to July 2014, 42 patients (median age 51 [18-71] years, male=76.2%) were selected for transportation using ECCS. Pulmonary failure was present in 25 patients, who were provided with veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac or cardiopulmonary failure dominated in 17 patients, who underwent implantation of extracorporeal life support (ECLS). Cannulas were inserted percutaneously, employing the Seldinger technique.

Results: After ECCS-implantation, a prompt stabilization of the cardiopulmonary function could be achieved in all patients. The patients were transported by ambulance over a distance of 1-95 km. Transport was uneventful in all cases without any technical complications. On arrival at the specialized center, two patients presented with leg ischemia and underwent relocation of the arterial cannula. One patient had a cannula displacement requiring repositioning. After a median support of 13 [10-17] days for ECMO, and 8 [3-14] days for ECLS, 48.0%, and 29.4%, of patients, respectively, could be successfully weaned from the systems. Discharge rates were 44.0% for ECMO, and 11.8% for ECLS.

Conclusions: With a trained team, modern ECCS therapy allows location-independent, out-of-center stabilization and a safe interhospital transfer of critically ill patients to a specialized center.