Multiple Modality Transport of a Patient in Cardiogenic Shock

Patients presenting with acute myocardial infarction and cardiogenic shock unresponsive to pressors show improved survival rates when placed on emergent cardiopulmonary support. This modality allows the patient to be sustained until blood flow can be returned to the myocardium by intervention from percutaneous balloon angioplasty (PTCA) or surgical revascularization. Additionally, if myocardial damage is severe, continued life support has been demonstrated successful as a bridge to transplant. Institutions that lack transplant technology depend on specific transport capabilities to institutions that have the resources. Techniques must often be developed as a case presents to provide safe and effective transport of these patients. This case-report demonstrates a patient requiring multiple modalities of support including intra-aortic balloon pump (IABP), percutaneous cardiopulmonary support (CPS) replaced by cardiopulmonary bypass with gravity venous drainage (CPB) and inotropic support to successfully maintain hemodynamics for revascularization prior to mobile intensive care unit (MICU) and fixed-winged transport to a transplant facility. The staff was required to adapt the cardiopulmonary bypass circuit on line to fit the space and functionality restraints of the MICU and aircraft. Supplies needed to be accumulated that would not only allow CPB to be safely maintained, but also provide emergency backup if equipment failed or became damaged en route.

This manuscript will be presented at the 10th annual Perfusion Research and Education Foundation Meeting. For more information visit http://www.pref.org