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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...

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Autores principales: Hildreth, Brianna A., Panarello, Giovanna, Martucci, Gennaro, Tuzzolino, Fabio, Piacentini, Alberto, Occhipinti, Giovanna, Giunta, Andrea, Genco, Fabio, Raffa, Giuseppe M., Pilato, Michele, Capitanio, Guido, Arcadipane, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002579/
https://www.ncbi.nlm.nih.gov/pubmed/33802762
http://dx.doi.org/10.3390/membranes11030210
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author Hildreth, Brianna A.
Panarello, Giovanna
Martucci, Gennaro
Tuzzolino, Fabio
Piacentini, Alberto
Occhipinti, Giovanna
Giunta, Andrea
Genco, Fabio
Raffa, Giuseppe M.
Pilato, Michele
Capitanio, Guido
Arcadipane, Antonio
author_facet Hildreth, Brianna A.
Panarello, Giovanna
Martucci, Gennaro
Tuzzolino, Fabio
Piacentini, Alberto
Occhipinti, Giovanna
Giunta, Andrea
Genco, Fabio
Raffa, Giuseppe M.
Pilato, Michele
Capitanio, Guido
Arcadipane, Antonio
author_sort Hildreth, Brianna A.
collection PubMed
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.
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spelling pubmed-80025792021-03-28 ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms Hildreth, Brianna A. Panarello, Giovanna Martucci, Gennaro Tuzzolino, Fabio Piacentini, Alberto Occhipinti, Giovanna Giunta, Andrea Genco, Fabio Raffa, Giuseppe M. Pilato, Michele Capitanio, Guido Arcadipane, Antonio Membranes (Basel) Article 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. MDPI 2021-03-17 /pmc/articles/PMC8002579/ /pubmed/33802762 http://dx.doi.org/10.3390/membranes11030210 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Article
Hildreth, Brianna A.
Panarello, Giovanna
Martucci, Gennaro
Tuzzolino, Fabio
Piacentini, Alberto
Occhipinti, Giovanna
Giunta, Andrea
Genco, Fabio
Raffa, Giuseppe M.
Pilato, Michele
Capitanio, Guido
Arcadipane, Antonio
ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002579/
https://www.ncbi.nlm.nih.gov/pubmed/33802762
http://dx.doi.org/10.3390/membranes11030210
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