Extracorporeal life support for management of refractory cardiac or respiratory failure: Initial experience in a tertiary centre

Adriano Peris, Giovanni Cianchi, Simona Biondi, Manuela Bonizzoli, Andrea Pasquini, Massimo Bonacchi, Marco Ciapetti, Giovanni Zagli, Simona Bacci, Chiara Lazzeri, Pasquale Bernardo, Erminia Mascitelli, Guido Sani, Gian F. Gensini

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals.Methods: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation.Results: A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62% survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50%. No patients on V-A ECLS support after cardiac arrest survived (N = 4).Conclusions: In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.

Original languageEnglish
Article number28
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume18
Issue number1
DOIs
Publication statusPublished - May 21 2010

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Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Heart Failure
Adult Respiratory Distress Syndrome
Heart Arrest
Severe Acute Respiratory Syndrome
H1N1 Subtype Influenza A Virus
Tissue and Organ Procurement
Cardiogenic Shock
District Hospitals
Trauma Centers
Tertiary Care Centers
Resuscitation
Teaching Hospitals
Italy
Hospital Emergency Service

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Extracorporeal life support for management of refractory cardiac or respiratory failure : Initial experience in a tertiary centre. / Peris, Adriano; Cianchi, Giovanni; Biondi, Simona; Bonizzoli, Manuela; Pasquini, Andrea; Bonacchi, Massimo; Ciapetti, Marco; Zagli, Giovanni; Bacci, Simona; Lazzeri, Chiara; Bernardo, Pasquale; Mascitelli, Erminia; Sani, Guido; Gensini, Gian F.

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 18, No. 1, 28, 21.05.2010.

Research output: Contribution to journalArticle

Peris, A, Cianchi, G, Biondi, S, Bonizzoli, M, Pasquini, A, Bonacchi, M, Ciapetti, M, Zagli, G, Bacci, S, Lazzeri, C, Bernardo, P, Mascitelli, E, Sani, G & Gensini, GF 2010, 'Extracorporeal life support for management of refractory cardiac or respiratory failure: Initial experience in a tertiary centre', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 18, no. 1, 28. https://doi.org/10.1186/1757-7241-18-28
Peris, Adriano ; Cianchi, Giovanni ; Biondi, Simona ; Bonizzoli, Manuela ; Pasquini, Andrea ; Bonacchi, Massimo ; Ciapetti, Marco ; Zagli, Giovanni ; Bacci, Simona ; Lazzeri, Chiara ; Bernardo, Pasquale ; Mascitelli, Erminia ; Sani, Guido ; Gensini, Gian F. / Extracorporeal life support for management of refractory cardiac or respiratory failure : Initial experience in a tertiary centre. In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2010 ; Vol. 18, No. 1.
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abstract = "Introduction: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals.Methods: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation.Results: A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62{\%} survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50{\%}. No patients on V-A ECLS support after cardiac arrest survived (N = 4).Conclusions: In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.",
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T1 - Extracorporeal life support for management of refractory cardiac or respiratory failure

T2 - Initial experience in a tertiary centre

AU - Peris, Adriano

AU - Cianchi, Giovanni

AU - Biondi, Simona

AU - Bonizzoli, Manuela

AU - Pasquini, Andrea

AU - Bonacchi, Massimo

AU - Ciapetti, Marco

AU - Zagli, Giovanni

AU - Bacci, Simona

AU - Lazzeri, Chiara

AU - Bernardo, Pasquale

AU - Mascitelli, Erminia

AU - Sani, Guido

AU - Gensini, Gian F.

PY - 2010/5/21

Y1 - 2010/5/21

N2 - Introduction: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals.Methods: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation.Results: A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62% survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50%. No patients on V-A ECLS support after cardiac arrest survived (N = 4).Conclusions: In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.

AB - Introduction: Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals.Methods: At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation.Results: A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62% survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50%. No patients on V-A ECLS support after cardiac arrest survived (N = 4).Conclusions: In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.

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