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Open Access 01-12-2021 | Cardiogenic Shock | Research article

ECLS supported transport of ICU patients: does out-of -house implantation impact survival?

Authors: Felix Fleissner, Alexandru Mogaldea, Andreas Martens, Ruslan Natanov, Stefan Rümke, Jawad Salman, Tim Kaufeld, Fabio Ius, Erik Beckmann, Axel Haverich, Christian Kühn

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

Extracorporeal life support (ECLS) is an established tool to stabilize severely ill patients with therapy-refractory hemodynamic or respiratory failure. Recently, we established a mobile ECLS retrieval service at our institution. However, data on the outcome of patients receiving ECLS at outside hospitals for transportation into tertiary hospitals is still sparse.

Methods

We have analyzed all patients receiving ECLS in outside hospitals (Transport group, TG) prior to transportation to our institution and compared the outcome to our in-house ECLS experience (Home Group, HG).

Results

Between 2012 and 2018, we performed 978 ECLS implantations, 243 of which were performed on-site in tertiary hospitals for ECLS supported transportation. Significantly more veno-venous systems were implanted in TG (n = 129 (53%) vs. n = 327 (45%), p = 0.012). Indication for ECLS support differed between the groups, with more pneumonia; acute respiratory distress syndromes in the TG group and of course, more postcardiotomy patients in HG. Mean age was 47 (± 20) (HG) vs. 48 (± 18) (TG) years, p = 0.477 with no change over time. No differences were seen in ECLS support time (8.03 days ±8.19 days HG vs 7.81 days ±6.71 days TG, p = 0.675). 30-day mortality (n = 379 (52%) (HG) vs. n = 119 (49%) (TG) p = 0.265) and death on ECLS support (n = 322 (44%) (HG) vs. n = 97 (40%) TG, p = 0.162) were comparable between the two groups, despite a more severe SAVE score in the v-a TG (HG: − 1.56 (± 4.73) vs. TG -3.93 (± 4.22) p < 0.001). Mortality rates did not change significantly over the years. Multivariate risk analysis revealed Influenza, Peak Insp. Pressure at implantation, pO2/FiO2 ratio and ECLS Score (SAVE/RESP) as well as ECLS support time to be independent risk factors for mortality.

Conclusion

Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 h/7d ECLS standby for secondary and primary hospitals as a tertiary hospital. Increasing indications and total numbers for ECLS support raise the need for further studies to evaluate outcome in these patients.

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Title: ECLS supported transport of ICU patients: does out-of -house implantation impact survival?
Authors: Felix Fleissner
Alexandru Mogaldea
Andreas Martens
Ruslan Natanov
Stefan Rümke
Jawad Salman
Tim Kaufeld
Fabio Ius
Erik Beckmann
Axel Haverich
Christian Kühn
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Cardiogenic Shock
Cardiogenic Shock
Acute Respiratory Distress-Syndrome
ECMO
ECMO
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01508-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

ECLS supported transport of ICU patients: does out-of -house implantation impact survival?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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