One-Year Experience With a Mobile Extracorporeal Life Support Service.
The Annals of thoracic surgery · 2017-06-29 · Observational study
Abstract
BACKGROUND: Severe acute respiratory distress syndrome is associated with a high mortality rate. The International Extracorporeal Membrane Oxygenation Network recommends regionalization of extracorporeal life support (ECLS) to high-volume centers and development of mobile ECLS teams to rescue patients with severe acute respiratory disease. METHODS: A tertiary medical center developed a mobile team and the infrastructure to support a ECLS transport service available 24 hours a day, 7 days a week. We conducted a retrospective study of all consecutive patients presenting for ECLS for severe acute respiratory distress syndrome from outside hospitals through our mobile ECLS program associated with hemodynamic instability from January 1, 2015, until December 31, 2015. RESULTS: During the study period, 106 consultations for ECLS were received, and 36 patients were placed on ECLS. Of these 36 ECLS patients, 11 were deemed stable enough for transport before ECLS, and 21 required mobile ECLS by the mobile ECLS, with a survival of 67% (14 of 21). The other 4 ECLS patients were inhouse patients and therefore received ECLS in a nonmobile fashion. In addition, 28 patients were transferred to our hospital who did not receive ECLS. Patient survival increased significantly with increased experience with the program, as the highest mortality rates were early in the program (p = 0.006), and in conjunction with stricter adherence to our exclusion criteria. CONCLUSIONS: The formation of a mobile ECLS program is a complex undertaking that took 2 years of planning to develop. Development of criteria for ECLS implementation can guide appropriate resources utilization and may prevent their use in patients with little to no chance of survival.
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Tags
ECMO & mechanical circulatory support · Interfacility & critical care transport · Mortality & survival
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