Capabilities of a mobile extracorporeal membrane oxygenation service for severe respiratory failure delivered by intensive care specialists

Abstract

SummaryWe conducted a single-centre observational study of retrievals for severe respiratory failure over 12 months. Our intensivist-delivered retrieval service has mobile extracorporeal membrane oxygenation capabilities. Sixty patients were analysed: 34 (57%) were female and the mean (SD) age was 44.1 (13.6) years. The mean (SD) PaO 2 /F I O 2 ratio at referral was 10.2 (4.1) kPa and median (IQR [range]) Murray score was 3.25 (3.0-3.5 [1.5-4.0]). Forty-eight patients (80%) required veno-venous extracorporeal membrane oxygenation at the referring centre. There were no cannulation or extracorporeal membrane oxygenation-related complications. The median (IQR [range]) retrieval distance was 47.2 (14.9-77.0 [2.3-342.0]) miles. There were no major adverse events during retrieval. Thirty-seven patients (77%) who received extracorporeal membrane oxygenation survived to discharge from the intensive care unit and 36 patients (75%) were alive after six months. Senior intensivist-initiated and delivered mobile extracorporeal membrane oxygenation is safe and associated with a high incidence of survival.

Heparin-free continuous vena-venous hemofiltration as a veno-venous bypass in inferior vena cava reconstruction

“…Inferior vena cava interruption time limit operation time, VVB could overcome the physiological and pathological changes after interrupting inferior vena cava. 4 However, establishing VVB takes time, with more complications, and expensive. Nowadays, CVVH therapy is an effective treatment used in clinic.…”

“…At present, the use of veno-venous extracorporeal bypass break operation time limit of inferior vena cava interruption. 4 However, the veno-venous bypass (VVB) also has its own adverse effects, such as accidental decannulation, circuit clots, thrombotic events, prolongation of operation time, vessel injury, and coagulopathy. 5 In addition, some small hospital commonly does not have cardiopulmonary bypass equipment, and it is therefore easy to result in irreversible harmful effects on patients.…”

Standardised signage for emergency drug location

“…[1]. Included patients were young (mean age 44.1 years) and very unwell (mean pH 7.14, with 68% receiving vasopressor infusions, 18% on renal replacement therapy and 92% with severe acute respiratory distress syndrome), yet 77% survived to discharge from intensive care and 75% were alive at six months.…”

“…We read with interest the correspondence regarding the potential hazards associated with the variety of drug labels and packaging currently in use throughout the UK [1], as this is an issue we have been trying to address within our hospital as part of a service improvement exercise. During this project we became aware of similar issue, which has the potential to exacerbate the problems encountered with non-standardised drug labels, namely the varied location of drugs within anaesthetic room cupboards.…”

The development of a mobile ECMO program

“…Rationale: Transport of critically ill patients on extracorporeal membrane oxygenation (ECMO) can be challenging; however, this has been demonstrated to be safe and feasible if undertaken by adequately trained teams, 1–3 with appropriate equipment and a platform that can accommodate the team and allows full access to the patient.…”