Extracorporeal life support service in a regional referral center: the Florence experience

Introduction

Extracorporeal life support (ECLS) represents a therapeutic choice in cases of acute reversible lung and/or heart failure. An emergency ICU can safely manage both veno-arterial (V-A) and veno-venous (V-V) ECLS.

Methods

In our experience, the ECLS treatment implementation started on April 2008. The ECLS team is composed of intensivists, cardiac surgeons, cardiologists, perfusionists and nurses. All of these figures were trained in ECLS management. An Emergency Medical Service has been equipped to guarantee rapid and safe ECLS positioning in peripheral hospitals and transportation to our referral center by the ECLS team. According to our internal protocol, eligible patients for V-V ECLS treatment are aged 15 to 70 years old and affected by ARDS with a PaO₂/FiO₂ ratio <60 or pH <7.20, under a protective ventilation setting. The use of ECLS for cardiac support is reserved for those cases of cardiac shock refractory to standard treatments and cardiac arrest not responding to advanced cardiac life support (ACLS). The ECLS device used is a Rotaflow Maquet Centrifugal Pump with a Quadrox-D oxygenator (Maquet, Rastatt, Germany) and biocoated circuits.

Results

From April 2008 to November 2009, 21 patients were treated with ECLS. In 13 patients V-V ECLS was established due to severe ARDS not responding to conventional treatment. Median SAPS II at admission was 49 and median duration was 235 hours. Three out of 13 patients were cannulated by the ECLS team in peripheral hospitals and safety transported. The intra-ICU survival rate was 62%. ECLS for cardiac support was performed in eight patients: four cases of intrahospital cardiac arrest, four cases of cardiogenic shock. Median stay of V-A ECLS was 110 hours. In cases of V-A ECLS due to cardiac arrest, no positive outcome was observed. The median stay of ACLS maneuvers before ECLS start was 62.5 minutes In cases of cardiogenic shock undergoing ECLS, two out of four patients were discharged from our ICU.

Conclusions

A complete competence acquisition for ECLS management makes this system a safe and feasible technique. The possibility to guarantee a safe treatment must involve different specialists and properly trained nurses. We found the importance of a well-timed start of ECLS.