| Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock. | |
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MedLine Citation:
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PMID: 21349735 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objective: Cardiogenic shock is associated with mortality rates up to 70%, even if patients are treated with intensive care support or thrombolytic therapy. Early coronary revascularisation can be life-saving but it is oftentimes not available at the hospital to which the patient was initially taken. Up to now, transferring patients in a state of severe cardiogenic shock and/or cardiopulmonary resuscitation is mostly decided to be impossible. We report on the use of two newly developed minimised systems for hand-held-extracorporeal membrane oxygenation (ECMO) (ELS-System™ and CARDIOHELP™, both from MAQUET Cardiopulmonary AG, Germany), which we have used for rapid extracorporeal life support and interhospital transfer on Mini-ECMO. We characterise the emergency use, safety instructions and bridging function of these novel Mini-ECMO devices. Methods: Between June 2007 and August 2010, we administered percutaneous Mini-ECMO support to 21 adult cardiogenic shock patients. The main components of each Mini-ECMO system are a centrifugal pump and a membrane oxygenator. The systems can act independently from wall connection points, and are they are small enough to be attached nearby a patient's side during transport. Results: On ECMO, gas exchange improved significantly, vasopressor support could be significantly marked down and signs of shock disappeared in all patients. Emergency medical service was carried out in re-established blood-flow and oxygen delivery. The patients were bridged to coronary artery bypass grafting (CABG) (n=6), ventricular assist device (n=1) or pulmonary embolectomy (n=1) or specialised intensive care (n=13). Thirteen patients (62%) had completely recovered. Conclusions: The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients. |
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Authors:
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Matthias Arlt; Alois Philipp; Sabine Voelkel; Daniele Camboni; Leopold Rupprecht; Bernhard-Martin Graf; Christof Schmid; Michael Hilker |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-2-22 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: - ISSN: 1873-734X ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-2-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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University Hospital Regensburg, Regensburg, Germany. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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