Interhospital transfer of ECMO-assisted patients in Martinique

• Published in: Annales françaises d'anesthésie et de réanimation Vol. 32; no. 5; pp. 307 - 314
• Main Authors: Roger, D, Dudouit, J-M, Résière, D, Mehdaoui, H, Courcier, D, Villain, L, Léonard, C, Roques, F, Lebreton, G
• Format: Journal Article
• Language: French
• Published: France 01.05.2013
• Subjects: Adult; Aircraft - economics; Ambulances - economics; Cardiology Service, Hospital - organization & administration; Catchment Area (Health); Costs and Cost Analysis; Durable Medical Equipment - economics; Durable Medical Equipment - statistics & numerical data; Ergonomics; Extracorporeal Membrane Oxygenation - instrumentation; Female; French Guiana; Guadeloupe; Hazardous Substances; Hospitals, University - economics; Hospitals, University - organization & administration; Humans; Male; Martinique; Middle Aged; Mobile Health Units - economics; Patient Transfer - economics; Patient Transfer - organization & administration; Surgery Department, Hospital - organization & administration; Transportation of Patients - economics; Transportation of Patients - methods; Transportation of Patients - utilization; Weights and Measures; West Indies
• ISSN: 1769-6623
• DOI: 10.1016/j.annfar.2013.03.003

The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean. All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected. Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34years old [16-64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7-29km), seven by helicopter (190-440km), and eight by plane (440-1430km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted. Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable.