For patients of French Guiana, 1585 km distant, the delays are longer (<6 hours) and variable depending on the aircraft available (jet / airliner / military transport). Indeed, we have worked with local staff on the establishment of procedures to reduce delays in providing in-flight direction by air traffic control in mobilizing air transport so that, at the present time, we can take care of a patient in Guadeloupe (198 km) within 90 minutes of the call and another in Saint-Martin/Saint-Barthelemy in 180 minutes. Our delivery times have reduced considerably since the beginning of our experience (Table 5). The telecommunication network between emergency departments and intensive care units in the French Caribbean, protocols and strict criteria for indications are an important part of the mechanism that determines the success of interventions. We believe that these results are due in part to technical mastery of circulatory support, partly to organization and optimization of logistics transfers and, finally, to the setting-up of a regional ‘network’ of multidisciplinary collaboration. The results achieved by our mobile unit are good and quite similar to those observed in the literature and encourage us to continue this activity. Similar experiments have already been reported in the literature, especially during the H1N1 flu epidemic. As this type of request was becoming more frequent, we developed a mobile unit.Īirborne transfers of patients under ECMO support are not unique. As a result, we decided to fly out to assist these patients and then repatriate them to our centre by air. These patients had been hospitalized several hundred kilometres from our centre and were not actually transferable by conventional means. In the early interventions, we had to respond rapidly to unusual requests: young patients had respiratory failure refractory to conventional resuscitation and appeared to be eligible for support by ECMO. All patients were repatriated by air on ECMO in good conditions and 10 were saved. No leg ischaemia or major bleeding were observed in our study population.īetween January 2010 and June 2011, our CSMU supported 12 patients in therapeutic impasse, located several hundred kilometres from our centre. One patient died under ECMO support after 51 days of assistance and another died on the 60th day after removal of ECMO (septic shock on infectious colitis). One patient subsequently benefited from heart transplantation after long-term circulatory support (HeartMate II). The mean duration of support was 12 days (range: 4–51). Implementation of ECMO and transfer of patients were uneventful. The aircraft used were military or civil types: Puma helicopter ( n = 3), CASA twin-engine transport ( n = 4), EC145 helicopter ( n = 2) or Learjet private jet ( n = 3). The average air transfer distance for patients on ECMO was 912 km (range: 198–1585 km), with an average flying time of 124 min (range: 45–255 min). Eight patients had acute respiratory distress syndrome and were assisted by veno-venous ECMO, carried out with percutaneous cannulation.įour patients had refractory cardiogenic shock, and were assisted by veno-arterial ECMO, implanted via a surgical open approach. No patient implanted by our team was left in a remote institution. This study aims to evaluate the feasibility of such a procedure and report the preliminary results and feedback of our experience, developed in a region which is unusual in terms of its socio-economic contrast, geographic isolation, remoteness and insularity: the Caribbean. These patients' transfers under ECMO support were carried out by air. The cardiac surgery department of the Fort de France University Hospital (Martinique, French West Indies) developed a circulatory support mobile unit (CSMU) to care for people from the French Caribbean with severe cardiogenic or pulmonary distress, who are highly catecholamine-dependent and unsuitable for conventional transportation. Guadeloupe, Saint Martin, Saint Barthelemy, Martinique and French Guiana (Guyane) are French overseas territories in the Caribbean area, hundreds of miles from each other and very far (more than 7000 km or 4400 miles) from the French motherland. The question: is this relevant, justified, realistic and desirable? We can therefore contemplate making such an outstanding technique commonplace. At a large number of technical centres, including those handling small volumes, it had become obvious over the last few years-and especially since the outbreak of H1N1-that supply creates its own demand in health care. Some specialists certainly believe it should be available in all intensive care units or cardiology departments. Given the success rate of such techniques, it is worth considering whether this technique should not be more widespread. Extra corporeal membrane oxygenation (ECMO) is usually available only in specialized centres for cardiac surgery.
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