• Interventional Techniques & Devices

• Cardiology & Cardiovascular Medicine
• Interventional Techniques & Devices

Extracorporeal life support (ECLS) may be indicated for patients with refractory cardiogenic shock as a bridge to cardiac transplant or for long-term mechanical circulatory support. In the French territories of the Caribbean, the ECLS is available for emergency cases, but heart transplantation and long-term circulatory assistance are not. Dabor Resiere, MD, University Hospital of Martinique, Martinique, France, discussed the feasibility of transatlantic ECLS-assisted patient transfers.

Venoarterial extracorporeal membrane oxygenation (ECMO) ECLS was used for 68 patients with cardiogenic shock during ST elevation myocardial infarction in Prof. Resiere's center between 2008 and 2014. Intensive care unit survival was 48%, and 6-month survival was 42% [Resiere D et al. SRLF 2013]. The ECMO device can be used to stabilize patients until they can receive a long-term device or transplantation.

ECMO support was used in 12 patients for air transfer to the University Hospital of Martinique from other French Caribbean territories [Lebreton G et al. Interact Cardiovasc Thorac Surg 2012]. The average distance was 912 km, with a flying time of 124 minutes. All patients had ECMO implantation and transfer without adverse events. The mean duration of support was 12 days. Eleven patients were weaned from ECMO; 1 underwent heart transplantation; 1 died under ECMO support after 51 days; and 1 died on Day 60 after ECMO removal (Table 1).

Before 2011, commercial airlines did not allow transfer of patients on ECLS support. In 2011, ground and in-flight testing led to an agreement with an airline to transfer patients. Subsequently, Prof. Reseire's group studied the feasibility of transatlantic transport of ECLS- treated patients. This prospective observational study included all patients treated by ECLS and admitted to the general intensive unit or the cardiothoracic surgical department of the University Hospital of Martinique and then transferred to France by plane. Ten patients were transferred on a commercial flight to Paris between September 2011 and February 2014, where they were included on the emergency transplant list. All transfers took place without incident. The outcomes for each patient are shown in Table 2.

ECLS with ECMO is a temporary therapeutic option for refractory cardiogenic shock as a bridge to permanent mechanical circulatory support or heart transplantation. Once ECLS has been initiated, patients require urgent transfer to a specialized center capable of offering destination therapies. In this case series, venoarterial ECMO-assisted transatlantic transport on a commercial flight appeared to be safe without any adverse events during device implantation and transfer and allowed several patients to receive advanced durable treatments for heart failure. As a result, patients living in the Antilles-Guiana region have the option to be transported to France, where they can be listed for emergency heart transplantation or undergo placement of a ventricular assist device.

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