ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms
The retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-03-01
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| Series: | Membranes |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0375/11/3/210 |
| _version_ | 1827697500214001664 |
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| author | Brianna A. Hildreth Giovanna Panarello Gennaro Martucci Fabio Tuzzolino Alberto Piacentini Giovanna Occhipinti Andrea Giunta Fabio Genco Giuseppe M. Raffa Michele Pilato Guido Capitanio Antonio Arcadipane |
| author_facet | Brianna A. Hildreth Giovanna Panarello Gennaro Martucci Fabio Tuzzolino Alberto Piacentini Giovanna Occhipinti Andrea Giunta Fabio Genco Giuseppe M. Raffa Michele Pilato Guido Capitanio Antonio Arcadipane |
| author_sort | Brianna A. Hildreth |
| collection | DOAJ |
| description | The retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a vast area in southern Italy and Malta. This observational, descriptive study includes all patients that required veno–venous (V-V) ECMO and transport by a mobile team between October 2009 and May 2020. Linear and multiple logistic regressions were applied to explore the risk factors for mortality in the ICU. Kaplan–Meier estimates were generated to predict the survival in patients transported by helicopter or ambulance, and the two cohorts were compared according to their baseline characteristics. Of 122 patients transported, 89 (73%) survived to ICU discharge (50 (41%) patients were transported by ambulance, and 72 (59%) were transported by helicopter). Independent predictive factors associated with mortality in a stepwise multiple regression model were prone positioning, acute kidney injury, and the number of days spent on mechanical ventilation (MV). Kaplan–Meier estimates for survival favored the helicopter cohort (79%) rather than the ambulance cohort (64%). Patients transported by helicopter had better pre-ECMO profiles, with shorter hospital and ICU stays, a shorter duration of MV use, and higher RESP scores, which indicate better survival probabilities. ECMO transport can be carried out safely over long distances; in rural areas with underdeveloped roads, transportation via helicopter or ambulance can extend the arm of the hospital to remote areas. Early ECMO initiation can be crucial in improving survival outcomes, and when transportation is the limiting factor to starting ECMO support, it should be attempted at the earliest logistical stage possible. |
| first_indexed | 2024-03-10T13:09:53Z |
| format | Article |
| id | doaj.art-9ed82e01ad634f99a57626bdcb115b82 |
| institution | Directory Open Access Journal |
| issn | 2077-0375 |
| language | English |
| last_indexed | 2024-03-10T13:09:53Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Membranes |
| spelling | doaj.art-9ed82e01ad634f99a57626bdcb115b822023-11-21T10:49:52ZengMDPI AGMembranes2077-03752021-03-0111321010.3390/membranes11030210ECMO Retrieval over the Mediterranean Sea: Extending Hospital ArmsBrianna A. Hildreth0Giovanna Panarello1Gennaro Martucci2Fabio Tuzzolino3Alberto Piacentini4Giovanna Occhipinti5Andrea Giunta6Fabio Genco7Giuseppe M. Raffa8Michele Pilato9Guido Capitanio10Antonio Arcadipane11School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyResearch Office, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyPerfusion Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyEmergency Rescue Service, 118 Service—Region of Sicily, 91021 Sicily, ItalyCardiac Surgery Unit, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyCardiac Surgery Unit, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, ItalyThe retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a vast area in southern Italy and Malta. This observational, descriptive study includes all patients that required veno–venous (V-V) ECMO and transport by a mobile team between October 2009 and May 2020. Linear and multiple logistic regressions were applied to explore the risk factors for mortality in the ICU. Kaplan–Meier estimates were generated to predict the survival in patients transported by helicopter or ambulance, and the two cohorts were compared according to their baseline characteristics. Of 122 patients transported, 89 (73%) survived to ICU discharge (50 (41%) patients were transported by ambulance, and 72 (59%) were transported by helicopter). Independent predictive factors associated with mortality in a stepwise multiple regression model were prone positioning, acute kidney injury, and the number of days spent on mechanical ventilation (MV). Kaplan–Meier estimates for survival favored the helicopter cohort (79%) rather than the ambulance cohort (64%). Patients transported by helicopter had better pre-ECMO profiles, with shorter hospital and ICU stays, a shorter duration of MV use, and higher RESP scores, which indicate better survival probabilities. ECMO transport can be carried out safely over long distances; in rural areas with underdeveloped roads, transportation via helicopter or ambulance can extend the arm of the hospital to remote areas. Early ECMO initiation can be crucial in improving survival outcomes, and when transportation is the limiting factor to starting ECMO support, it should be attempted at the earliest logistical stage possible.https://www.mdpi.com/2077-0375/11/3/210ARDShelicoptertransportationHEMS |
| spellingShingle | Brianna A. Hildreth Giovanna Panarello Gennaro Martucci Fabio Tuzzolino Alberto Piacentini Giovanna Occhipinti Andrea Giunta Fabio Genco Giuseppe M. Raffa Michele Pilato Guido Capitanio Antonio Arcadipane ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms Membranes ARDS helicopter transportation HEMS |
| title | ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms |
| title_full | ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms |
| title_fullStr | ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms |
| title_full_unstemmed | ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms |
| title_short | ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms |
| title_sort | ecmo retrieval over the mediterranean sea extending hospital arms |
| topic | ARDS helicopter transportation HEMS |
| url | https://www.mdpi.com/2077-0375/11/3/210 |
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