The life expectancy of mankind is rising on a global scale like never before in history. The reasons are multifactorial but the most important factors accounted for this fact are better hygiene, the availability of better nutrition and for the developed countries, the benedictions of modern medicine. With an aging population we face new challenges in regards to support the patients in need of more invasive procedures and/or more complex diseases. One of the many new and fascinating technical devices which has been implemented in centers of excellence worldwide is the ECMO-Technology, the Extracorporeal-membrane-oxygenation, an extracorporeal life support device.
The ECMO-device creates a cardio-pulmonary bypass for short-term support by draining blood from the body to oxygenate outside of the body. Depending on the placement of the cannulas (venoarterial or veno-venous), the blood is returned to the arterial system and thus providing cardiac support or to the venous system without cardiac support.
MedCareProfessional is one of the few Ambulance companies in central Germany which specializes in transportation of patients with different kinds of extracorporeal-life-support devices, such as an ECMO-Device, by ground- as well as by air ambulance. In the following i would like a brief overview what we think is necessary and which kind of infrastructure should be available to ensure a successful relocation.
Patients with an already implanted ECMO-Device are by definition cardio-pulmonary instable. It may be because of pulmonary failure due to a severe infection or a cardiogenic shock due to cardia arrest. Nonetheless they are in need of an atraumatic approach due to their fragile status so following requirements should be met.
Personnel: Studies show that incidents occur quite often (min. 27, 3 % / Broman et al. Critical Care, 2015 19:278) and need to be met adequately, therefore we have experienced anesthesiologists/ intensivists as transport team leader. For their assistance we deploy specialized paramedics along them, with ECMO transport training. Furthermore it is necessary to have a cardio-technician in the team which can solely focus on the ECMOdevice. Of course there is another paramedic acting as the driver, which in case of emergencies can assist the team, should it be necessary.
Equipment: Mostly patients with an ECMO-device are intubated and ventilated. Usually they bring quite a range of medication with them and the therapy cannot be paused, it has to be applied continuously via syringe pumps. So in general we have an critical care respirator (“Hamilton-T1”), oxygen supply, the stretcher system (“Stryker Power-PRO XT”), where we attach up to eight Syringe pumps (“Injectomat MC Agilia”), the monitor system (“Zoll XSeries”), the ECMO-Device (“Cardiohelp System” Maquet) and of course all the tubes as well as wires.
Ambulance: With the personnel and equipment mentioned above, all of it sums up to quite some transportation load. And in case of incidents we need the space to work around and with the patient. Therefore we at MedCareProfessional use “MERCEDES-BENZ SPRINTER 519 CDI”, rebuilt by “Ambulanz Mobile”, in a customized ICU-Ambulance version for our company. In case of obese patients or need of more support devices we also make use of our larger “MERCEDES-BENZ ATEGO”, likewise rebuilt as an ICU-Ambulance. All of our ICUAmbulances (5 in total) have firmly installed mounting racks for the respirators, monitors as well as the ECMO-Device. Thus we have access at any given time and the risk of damaging the life-supporting equipment due to sliding during transportation is non-existent. All of our ICU-Ambulances have a redundant respiratory and monitoring system (second “Hamilton-T1” and “Zoll X-Series”) because we already know that the patients are critically-ill and are in need of assist and monitoring systems, so we made provisions by having a backup system in case of technical problems.
In short, it is necessary to deploy experienced and specialized personnel, have equipment which is state of the art to help the patient, which already is critically-ill and dependent on technical devices and at last have a vehicle which meets your and your patients needs in term of capacity and safety.
We would be glad to discuss this topic with you, so if you want further information or we can provide assistance with critically-ill patients with extracorporeal life support devices, please don’t hesitate to contact us and ask for our expertise.
Written by Dr.med.Vijay Lakhani Medical Director MedCareProfessional GmbH
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