This document discusses complex patient retrievals involving bariatric, intra-aortic balloon counterpulsation (IABP), and extracorporeal membrane oxygenation (ECMO) patients. It provides details on weight limits for different transport methods for bariatric patients. For IABP retrievals, it outlines indications, contraindications, and issues to consider. For ECMO retrievals, it discusses physiology, background on use during the 2009 H1N1 influenza outbreak, outcomes of 17 ECMO retrievals during that time with 89% survival, and similarities to other studies. Key points are that these complex retrievals are long missions requiring planning and involvement of consultants.

1. Complex Retrievals

2. Complex Retrievals
• Bariatric
• Intra‐aor5c Balloon Counterpulsa5on
• Extracorporeal Membrane Oxygena5on

3. Bariatric Retrievals
Max pa&ent weight
• Road ambulance ‐ 160 kg (58 cm)
• Air Ambulance fixed wing ‐ 110 kg
• Helicopter (AW 139)‐ 200 kg
• Mul5purpose vehicle ‐ 500 kg
• NB SIZE as well as WEIGHT

6. Bariatric Missions

8. Bariatric Retrievals
• Long missions
• Clinically challenging
• Require PLANNING
• Involve consultants (SRC / MRU)

9. IABP Retrievals

10. IABP indica5ons
•Hypotension unresponsive to other
Interven5ons
•Low output state
•Cardiogenic shock not reversed with drugs
•Acute MR esp papillary/vent septal rupture
•Recurrent ischaemic chest pain with signs
haemodynamic instability
•Refractory ventricular arrythmias

11. IABP transport
•Helicopter
•MPV
•Fixed wing

12. IABP contraindica5ons
•Significant AR or AV shun5ng
•AAA or aor5c dissec5on
•Uncontrolled sepsis
•Uncontrolled bleeding disorder
•Severe bilateral PVD
•Bilateral fem‐pop bypass gra^s

13. IABP issues
•Type of pump
•Securing
•Loading / unloading
•Power & Helium supply
•Sufficient clinical staff

15. IABP Retrievals
• Long missions
• Clinically challenging
• Require PLANNING
• Involve consultants (SRC / MRU)

16. ECMO

18. ECMO Physiology
• Oxygena5on of blood across a membrane in an
ar5ficial lung outside the body
• Venovenous ECMO for respiratory failure
• Venoarterial ECMO for circulatory failure
• Big pipes in big blood vessels
• A pump
• An oxygenator
• A heater

19. Background
• H1N1 2009 191 deaths (8.7/106)
• First death 2nd July 2009
• 722 pa5ents admieed to ICU
• 486 mechanical ven5la5on, 68 ECMO
• 79% ECMO survival rate
Australia, New Zealand Extracorporeal Membrane Oxygena5on (ANZ ECMO) Influenza
Inves5gators; Davies A, Jones D, Bailey M, et al: Extracorporeal membrane oxygena5on for 2009
influenza A (H1N1) acute respiratory distress syndrome. JAMA 2009; 302: 1888 –1895

26. June 1st – 31st August 2009
• 19 ECMO referrals
• 17 ECMO retrievals
• Age 25 ‐ 59 years
• Median weight was 110kg

27. Distance

28. Timelines

29. Safety of ECMO retrieval
• 4 cri5cal events
– 2 equipment‐related
• Baeery failure – hand pump un5l vehicle power available
• Air in line (3‐way tap opened) – pump stopped;
aspirated; restarted
– 2 pa5ent‐related
• SVT – an5‐arrhythmics / Mg2+ / DCCV
• Hypotension – vasoac5ve drug commenced

30. Outcomes
17/19 survival to hospital discharge (89%)
cf. ELSO registry severe ARDS 50% survival
(n=1473)
Brogan T, Thiagarajam R, Rycus P, Bartlee R, Braeon S. Extracorporeal
membrane oxygena5on in adults with severe respiratory failure: a mul5‐center
database. Intens Care Med 2009;35:2105‐2114

31. Outcomes
In published studies on adult1 and infant2
ECMO, deaths occurred prior to and during
transporta5on
1. Peek G, Mugford M, Tiruvoipa5 R et al. Efficacy and economic assessment of
conven5onal ven5latory support versus extracorporeal membrane oxygena5on
for severe adult respiratory failure (CESAR): a mul5centre randomised
controlled trial. Lancet 2009; 374 (9698) 1351‐63
2. Boedy R, Howell C, Kanto W. Hidden mortality rate associated with
extracorporeal membrane oxygena5on. J Pediatr 1990;117:462‐464

34. ECMO Retrievals
• Long missions
• Clinically challenging
• Require PLANNING
• Involve consultants (SRC / MRU)

35. Complex Retrievals
• Long missions
• Clinically challenging
• Require PLANNING
• Involve consultants (SRC / MRU)