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Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure
Author(s) -
Arlt Matthias,
Philipp Alois,
Zimmermann Markus,
Voelkel Sabine,
Amann Matthias,
Bein Thomas,
Müller Thomas,
Foltan Maik,
Schmid Christof,
Graf Bernhard,
Hilker Michael
Publication year - 2009
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2009.00860.x
Subject(s) - extracorporeal membrane oxygenation , medicine , cardiopulmonary bypass , intensive care medicine , oxygenation , extracorporeal , anesthesia
Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia‐dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out‐of‐center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand‐held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY‐LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand‐held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO 2 removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out‐of‐center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand‐held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.