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

Journal of Cardiothoracic Surgery, 1/ 2021

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

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 post cardiotomy patients inHG. 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.

Keywords:

ECLS, Transport, ARDS, Cardiogenic shock

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