Patients are considered for VA-ECLS for cardiogenic shock and postcardiotomy syndrome. Selection criteria for COVID-19 evolved because multicenter data suggested poor survival for those intubated for prolonged durations or of advanced age. For COVID-19 respiratory failure, ideal candidates are those intubated <7 days, younger than age 60 years (initially age 65 years), with body mass index <45, in addition to the above parameters. Suitable patients have typically failed medical therapies, including neuromuscular blockade and prone positioning. We consider patients for venovenous ECLS for refractory hypoxemic or hypercapnic respiratory failure with Pa o 2/F io 2 <100 mm Hg or pH <7.2 despite maximal ventilatory support. Conclusionsīoth VA- and VV-ECLS modalities are evaluated on an individualized basis. Survival to discharge was 67.3% for those requiring venovenous-ECLS for non–COVID-19 respiratory failure, 52.4% for those with COVID-19%, and 54.1% for those requiring venoarterial-ECLS. Extracorporeal circulation was established within a median of 45 minutes (IQR, 30-55 minutes) after team arrival.
Patients were transported using a ground ambulance from 50 institutions with a median distance of 27.5 miles (IQR, 18.7-48.0 miles). The median pre-ECLS Pa o 2:F io 2 for venovenous-ECLS was 64 mm Hg (interquartile range, 53-75 mm Hg) and 95.8 mm Hg (IQR, 55-227 mm Hg) for venoarterial-ECLS, whereas median pH and base deficit were 7.25 (IQR, 7.16-7.33) and 7 mmol/L (IQR, 4-11 mmol/L) for those requiring venoarterial-ECLS. The most common indications for mobile ECLS were acute respiratory failure (46.4%), COVID–19-associated respiratory failure (19.1%), cardiogenic shock (18.2%) and postcardiotomy syndrome (11.8%). Of 110 patients transported to our institution on ECLS, 65.5% required venovenous, 30.9% peripheral venoarterial, and 3.6% central venoarterial support.
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