A New System For Hand-held Extracorporeal Membrane OxygenationYou must be a full Eusem member to view this file Go backA new system for hand-heldExtracorporeal Membrane OxygenationMatthias Arlt M.D.Department of AnesthesiologyAir Medical Service RegensburgUniversity Hospital Regensburg, GermanyChairman: Bernhard Graf PhD, M.D.Evolution in Cardiopulmonary Bypass TechnologyCABG Procedures 1998-2007Field of responsibility: 1.5 millions residentsDepartments of Anesthesiology and Cardiothoracic SurgeryMedical Service 2007 810 Rescue missions 398 Interhospital transfers24 hours in service Changes in the organisation of the medical systems Decreasing number of hospitals in rural areas Centralisation of medical technology and specialists Interhospital transfer of patients in cardiopulmonary deteriorationInterhospital transport of critically ill patientsKoppenberg J. Taeger K.: Current opinion in Anaesthesiology 2002;15:211-215 Too ill to be moved? Patients with severe lung and / or cardiac failure have to be moved to specialized centre Interhospital transfer of critically ill patients is risk laden Withholding transfer eliminates the choice of advanced treatment options In these cases, death to hypoxia has to be acceptedLovell MA et al.: Interhospital transport of critically ill patients: complications and difficulties.Anaest Intensive Care 2001;29:400-405 Cardiogenic shock patientsEarly revascularization resulted in lower mortality. We recommend that early revascularization be strongly considered for patients with acute myocardial infarction complicated by cardiogenic shock.Early revascularization in acute myocardial infarction complicated by cardiogenic shock.J.S. Hochman et.al. The New England Journal of Medicine Volume 341 Number 9 625-634 Emergency Medical Service EMS in cardiogenic shock patientsEmergency medical transport systems may need to take patients with complicated acute myocardialinfarction to hospitals with the capability to perform urgent revascularization.Cardiogenic shock. S. Topalian et al. Cardiogenic shock. Crit Care Med. 2008 Vol. 36, Suppl 1 S 66-74The role of Extracorporeal Life SupportIn patients who have acute and severe respiratory failure who are failing all advanced modes of mechanical ventilation, the use of extracorporeal life support is an optionMark R. Hemmila Crit Care Med 2006 Vol. 34, No. 9 The use of Extracorporeal Life Support in EMSLinden et al. Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation- national and international experience. Intensive Care Med 2001;27:1643-1648 Closed loop extracorporeal circulation system Powered by Rotaflow centrifugal pump Diffusion membran oxygenator Quadrox ELS Heparin-coated circuits tip-to-tip Self contained, independent system Anticoagulation: No full dose heparinization Downsized weight of 27 kg A new system for hand-held ECMO (ELS-SYSTEM)Hand-held ECMO in Air Medical ServiceCARDIOPULMONARY FAILURE |