• Jason M Ali, Alain Vuylsteke, Jo-Anne Fowles, Stephen Pettit, Kiran Salaunkey, Sai Bhagra, Clive Lewis, Jayan Parameshwar, Anna Kydd, Chinmay Patvardhan, Nicola Jones, Antonio Rubino, Yasir Abu-Omar, Catherine Sudarshan, Steven Tsui, Pedro Catarino, David P Jenkins, and Marius Berman.
• Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom.
• J. Cardiothorac. Vasc. Anesth. 2020 Feb 1; 34 (2): 374-382.

ObjectivesThe authors describe the experience of patient transfer on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) used as a salvage therapy for refractory cardiogenic shock, examining feasibility and long-term outcomes.DesignA retrospective case series.SettingA tertiary referral cardiothoracic transplantation center.Participants And InterventionsSince 2012, the authors' multidisciplinary team has traveled to the referring center of 15 patients referred with refractory cardiogenic shock. Of these, 13 were instituted on VA ECMO support (8 peripheral and 5 central) and subsequently transferred to the authors' center. A further 11 patients were transferred to the authors' institution by the referring team, already having been placed on VA-ECMO (8 peripheral and 3 central).Measurements And Main ResultsAll patients were safely transferred. The distance travelled ranged from 16 to 341 miles. The median duration of support on VA-ECMO was 4 days, ranging from 1 to 24 days. The VA-ECMO support was weaned, or the patient underwent a definitive surgical management (including 4 undergoing cardiac transplantation and 3 pulmonary endarterectomy) in 15 (62.5%) patients. The median intensive care unit stay was 15 days (range 1-109). Overall 30-day survival for this patient cohort was 69.6% with 1-year survival of 59.8%. For patients who were weaned from VA-ECMO, the 30-day survival was 100% and 1-year survival 92.9%.ConclusionsThe authors' experience demonstrates the feasibility and survival benefit of a salvage VA-ECMO retrieval service for carefully selected patients with refractory cardiogenic shock. The authors suggest that a system based on the model of nationally commissioned severe respiratory failure services could be organized to support the transfer of these patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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