Air Ambulance Inter-Hospital ECMO Retrieval of H1N1 Associated ARDS Patient First of Its Kind Case Reported in India

Abstract

Extracorporeal membrane oxygenation (ECMO) is a revolutionary life-saving technology for patients with severe but potentially reversible pulmonary or cardiac failure or for patients in need of a bridge to transplantation. In the Indian scenario, the facility of ECMO is limited to few specialized healthcare centers having the expertise personnel and the equipment for this technology. However, the critically unwell patients with respiratory and/or cardiac failure are managed by all the healthcare facilities throughout the country. This has led to the development of mobile ECMO team which carries necessary equipment for initiation of ECMO at referral center and also retrieval of the patient on ECMO. We present the case of a patient with H1N1 influenza associated severe ARDS who was retrieved via air-medical transport (fixed wing aircraft) on ECMO by the mobile ECMO team of our center. In the present case, the patient was cannulated and ECMO was initiated at the referral hospital. This allowed a safe transfer of this patient with severe refractory hypoxemia to ECMO centre. The long or short-distance inter-hospital transport of critical patients with respiratory and/or cardiac failure is feasible and safer on ECMO as compared to the conventional methods of transport. The mobile ECMO teams have made this technology available to all even when the admitting hospital doesn’t have this facility and expertise. To the author’s knowledge, this is the first case reported in India of air-medical retrieval of a patient on ECMO. Key-wordsAcute respiratory distress syndrome (ARDS), Air ambulance, Extra corporeal membrane oxygenation (ECMO), H1N1 influenza (Swine flu), Hypoxia, Inter hospital transport INTRODUCTION Extra Corporeal Membrane Oxygenation (ECMO) has seen a remarkable recognition and evolution in its use in the last decade. ECMO has emerged as an invaluable tool in the hands of intensive care physicians in the management of patients with severe pulmonary and/or cardiac dysfunction refractory to conventional management [1] , especially in patients with severe acute respiratory distress syndrome (ARDS). Though it is not a treatment modality in itself, it serves as a crucial bridge to therapy in a critical patient, bargaining time for the treatment or the management to be effective. In India, ECMO is available only in few specialized centers, however, the patients with refractory respiratory Access this article online Quick Response Code Website: