080 Heliported ECMO for cardiogenic shock expands cardiac assist surgical programs

Objectives ECMO is an effective technique to provide emergency mechanical circulatory assistance for patients with cardiogenic shock refractory to conventional medical therapies. For patients outside our institution we create a Heliported Remote Cardiac Assist unit to implant the ECMO. Our study was undertaken to evaluate the feasibility of the procedure and the results of our experience. Methods Between March 2006 and June 2008 38 consecutive patients in acute cardiogenic shock were implanted with percutaneous ECMO by our heliported team. Results Mean distance from our ICU was 42 miles (1-143). Maximal time limit between phone call and implantation was 90 min. Mean LVEF evaluated by TTE was 19 ± 5%. Indications were fulminant myocarditis, pharmacologic suicide attempt, acute myocardial infarction, post-partum cardiopathy, end-stage dilated cardiomyopathy. They received a percutaneous veno-arterial femoral ECMO with immediate reperfusion of the limb. Seventeen patients (45%) were successfully weaned from ECMO after 9.4 ± 8.7 days. Four patients (11%) were transplanted. One patient (3%) was switched to a left ventricular assist device and successfully transplanted. Twenty-one patients (55%) survived to hospital discharge. Conclusions The Heliported Cardiac Remote Assist unit allowed the emergent implant of ECMO support and could rescue 55% of otherwise lethal cardiogenic shock patients in remote institutions.