Air evacuation of a patient with end-stage heart failure using full peripheral veno-arterial extracorporeal membrane oxygenation

Background. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is critical in the life support of patients with severe cardiovascular insufficiency, especially when traditional methods are not effective enough. There is no data on the full peripheral ECMO application during air transportation of patients with terminal heart failure in the Russian literature. Objective. To demonstrate the features of air medical transportation of a patient with terminal heart failure using VA-ECMO. Material and methods. Patient I., 41 years old with congenital heart disease (bicuspid aortic valve), aortic stenosis, acute heart failure with a left ventricular ejection fraction (LVEF) of 3% after the valve replacement operation. He underwent a surgery to replace the aortic valve with a mechanical prosthesis combined with aortic root reconstruction, which required VA-ECMO connection during the surgery and further medical evacuation by specialized flight IL-76 from Kaliningrad to Moscow for heart transplantation. Results. During the evacuation, the patient's condition remained extremely severe, but could be corrected by a team of intensive care specialists. In transportation, the following interventions were performed: full peripheral VA-ECMO with a blood flow of 6.6-6.81 L/min and an oxygen flow of 3 L/min, mechanical lung ventilation (MLV) 20 (FiO 2 of 0.4; PEEP 6; Ps 20; respiratory rate of 14/min; respiratory volume 540 ml, respiratory minute volume 7.8 L/min), druginduced depression of the central nervous system, temporary electrocardiostimulation, fluid and antibacterial therapy, vasopressor support with titration of inotropic drug infusion rate, monitoring of vital functions. The patient tolerated transportation satisfactorily and was transferred to the Intensive Care Unit of the Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs in a stable severe condition for assessing the chances of heart transplantation. Conclusions. The present clinical case confirms that air evacuation using ECMO is a promising strategy for patients with end-stage heart failure. The success depends on the arrangement of medical evacuation, pre–transport treatment, the medical staff qualifications and skills of working with mobile life support equipment. The use of air ambulance and mobile ECMO teams, especially in remote regions, can be a step towards creating a nationwide system of emergency medical care for patients with critical life support disorders.