Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective
Objective: Although extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiot...
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Elsevier
2022-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722000244 |
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| author | Joseph Hadaya, MD Yas Sanaiha, MD Vadim Gudzenko, MD Nida Qadir, MD Sumit Singh, MD Ali Nsair, MD Nam Yong Cho, BS Richard J. Shemin, MD Peyman Benharash, MD Ida Anderson Stephanie Bland David Boldt Rene Cardiel Wei Ting Chen Jennie Chinchilla Sara Crager Kim De La Cruz Ryan Dries Jessica Fries Joseph Meltzer Jacquelyn Gates Christopher Hernandez Marisa Hernandez-Morgan Wolf B. Kratzert Nikoloz Kutateladze Saba Lahar George Lim Ann McNeil Katelyn Mears Ashley Melendez Curtis Murata Christopher Ortiz Anthony Pagel Prachi Redkar Daniel Salib Jessica Samson Nancy Satou Lisa Toft Savonna Warren Michael Wolfe Andrew Young |
| author_facet | Joseph Hadaya, MD Yas Sanaiha, MD Vadim Gudzenko, MD Nida Qadir, MD Sumit Singh, MD Ali Nsair, MD Nam Yong Cho, BS Richard J. Shemin, MD Peyman Benharash, MD Ida Anderson Stephanie Bland David Boldt Rene Cardiel Wei Ting Chen Jennie Chinchilla Sara Crager Kim De La Cruz Ryan Dries Jessica Fries Joseph Meltzer Jacquelyn Gates Christopher Hernandez Marisa Hernandez-Morgan Wolf B. Kratzert Nikoloz Kutateladze Saba Lahar George Lim Ann McNeil Katelyn Mears Ashley Melendez Curtis Murata Christopher Ortiz Anthony Pagel Prachi Redkar Daniel Salib Jessica Samson Nancy Satou Lisa Toft Savonna Warren Michael Wolfe Andrew Young |
| author_sort | Joseph Hadaya, MD |
| collection | DOAJ |
| description | Objective: Although extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiotomy syndrome, cardiogenic shock, and COVID-19 acute respiratory failure. Methods: We performed a retrospective review of all patients transported to our institution through our mobile ECLS program from January 1, 2018, to January 15, 2021. Results: Of 110 patients transported to our institution on ECLS, 65.5% required venovenous, 30.9% peripheral venoarterial, and 3.6% central venoarterial support. The most common indications for mobile ECLS were acute respiratory failure (46.4%), COVID–19-associated respiratory failure (19.1%), cardiogenic shock (18.2%) and postcardiotomy syndrome (11.8%). The median pre-ECLS Pao2:Fio2 for venovenous-ECLS was 64 mm Hg (interquartile range [IQR], 53-75 mm Hg) and 95.8 mm Hg (IQR, 55-227 mm Hg) for venoarterial-ECLS, whereas median pH and base deficit were 7.25 (IQR, 7.16-7.33) and 7 mmol/L (IQR, 4-11 mmol/L) for those requiring venoarterial-ECLS. Patients were transported using a ground ambulance from 50 institutions with a median distance of 27.5 miles (IQR, 18.7-48.0 miles). Extracorporeal circulation was established within a median of 45 minutes (IQR, 30-55 minutes) after team arrival. Survival to discharge was 67.3% for those requiring venovenous-ECLS for non–COVID-19 respiratory failure, 52.4% for those with COVID-19%, and 54.1% for those requiring venoarterial-ECLS. Conclusions: Patients can be safely and expeditiously placed on ECLS across broad indications, utilizing ground transportation in an urban setting. Clinical outcomes are promising and comparable to institutional non-transfers and those reported by Extracorporeal Life Support Organization. |
| format | Article |
| id | doaj-art-e7160432c36144798ff0b3934c52da8a |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-e7160432c36144798ff0b3934c52da8a2025-08-20T03:36:37ZengElsevierJTCVS Techniques2666-25072022-04-0112789210.1016/j.xjtc.2021.12.011Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspectiveJoseph Hadaya, MD0Yas Sanaiha, MD1Vadim Gudzenko, MD2Nida Qadir, MD3Sumit Singh, MD4Ali Nsair, MD5Nam Yong Cho, BS6Richard J. Shemin, MD7Peyman Benharash, MD8Ida AndersonStephanie BlandDavid BoldtRene CardielWei Ting ChenJennie ChinchillaSara CragerKim De La CruzRyan DriesJessica FriesJoseph MeltzerJacquelyn GatesChristopher HernandezMarisa Hernandez-MorganWolf B. KratzertNikoloz KutateladzeSaba LaharGeorge LimAnn McNeilKatelyn MearsAshley MelendezCurtis MurataChristopher OrtizAnthony PagelPrachi RedkarDaniel SalibJessica SamsonNancy SatouLisa ToftSavonna WarrenMichael WolfeAndrew YoungDivision of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CalifDivision of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CalifDivision of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CalifDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, CalifDivision of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CalifDivision of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CalifDivision of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CalifDivision of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CalifDivision of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif; Address for reprints: Peyman Benharash, MD, UCLA David Geffen School of Medicine, CHS 62-249, 10833 Le Conte Ave, Los Angeles, CA 90095.Objective: Although extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiotomy syndrome, cardiogenic shock, and COVID-19 acute respiratory failure. Methods: We performed a retrospective review of all patients transported to our institution through our mobile ECLS program from January 1, 2018, to January 15, 2021. Results: Of 110 patients transported to our institution on ECLS, 65.5% required venovenous, 30.9% peripheral venoarterial, and 3.6% central venoarterial support. The most common indications for mobile ECLS were acute respiratory failure (46.4%), COVID–19-associated respiratory failure (19.1%), cardiogenic shock (18.2%) and postcardiotomy syndrome (11.8%). The median pre-ECLS Pao2:Fio2 for venovenous-ECLS was 64 mm Hg (interquartile range [IQR], 53-75 mm Hg) and 95.8 mm Hg (IQR, 55-227 mm Hg) for venoarterial-ECLS, whereas median pH and base deficit were 7.25 (IQR, 7.16-7.33) and 7 mmol/L (IQR, 4-11 mmol/L) for those requiring venoarterial-ECLS. Patients were transported using a ground ambulance from 50 institutions with a median distance of 27.5 miles (IQR, 18.7-48.0 miles). Extracorporeal circulation was established within a median of 45 minutes (IQR, 30-55 minutes) after team arrival. Survival to discharge was 67.3% for those requiring venovenous-ECLS for non–COVID-19 respiratory failure, 52.4% for those with COVID-19%, and 54.1% for those requiring venoarterial-ECLS. Conclusions: Patients can be safely and expeditiously placed on ECLS across broad indications, utilizing ground transportation in an urban setting. Clinical outcomes are promising and comparable to institutional non-transfers and those reported by Extracorporeal Life Support Organization.http://www.sciencedirect.com/science/article/pii/S2666250722000244extracorporeal membrane oxygenationextracorporeal life supporttransportrespiratory failurecardiogenic shockcritical care |
| spellingShingle | Joseph Hadaya, MD Yas Sanaiha, MD Vadim Gudzenko, MD Nida Qadir, MD Sumit Singh, MD Ali Nsair, MD Nam Yong Cho, BS Richard J. Shemin, MD Peyman Benharash, MD Ida Anderson Stephanie Bland David Boldt Rene Cardiel Wei Ting Chen Jennie Chinchilla Sara Crager Kim De La Cruz Ryan Dries Jessica Fries Joseph Meltzer Jacquelyn Gates Christopher Hernandez Marisa Hernandez-Morgan Wolf B. Kratzert Nikoloz Kutateladze Saba Lahar George Lim Ann McNeil Katelyn Mears Ashley Melendez Curtis Murata Christopher Ortiz Anthony Pagel Prachi Redkar Daniel Salib Jessica Samson Nancy Satou Lisa Toft Savonna Warren Michael Wolfe Andrew Young Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective JTCVS Techniques extracorporeal membrane oxygenation extracorporeal life support transport respiratory failure cardiogenic shock critical care |
| title | Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective |
| title_full | Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective |
| title_fullStr | Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective |
| title_full_unstemmed | Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective |
| title_short | Implementation and outcomes of an urban mobile adult extracorporeal life support programCentral MessagePerspective |
| title_sort | implementation and outcomes of an urban mobile adult extracorporeal life support programcentral messageperspective |
| topic | extracorporeal membrane oxygenation extracorporeal life support transport respiratory failure cardiogenic shock critical care |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722000244 |
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