2018年06月08日 18:21


ICEM2019 ドクターカーV3 - 500ー
MOREs の命名は軽米寿之医師です。

3cases of Prehospital ECPR in the Mobile Operating Room

Akihide Konn, Tatsuya Nodagashira,
Hachinohe City Hospital, Department of emergency and Critical Care Medicine,Japan

Introduction:Mobile Operating Room for Emergency surgery (MOREs) can be potentially effective for saving lives by starting Extracorporeal cardiopulmonary resuscitation (ECPR) from the site near the scene. MOREs brings 3Drs and the ECMO devices. We construct a simplified theater for 5 minutes. MOREs enables early ECMO implantation and emergency thoracotomy.
Case1:A-45-years-old woman accidentally felt from the bridge and drifted down the river to the sea in winter. The EMS pulled her up from the sea and found her in cardiac arrest. A rapid response car dispatched in advance and started the ACLS. MOREs with 3 doctors and 2 clinical engineers dispatched because she needed prehospital ECPR. We started ECPR in MOREs 5 minutes after unsuccessful standard ACLS resuscitation. She was transferred to the hospital for 20 minutes and rewarmed, then the return of spontaneous circulation was archieved. Days2, she was weaned from venoarterial extracorporeal membrane oxygenation (V-A ECMO) and mechanical ventilator. Days4, she was discharged from the intensive care unit and a few days later, she left the hospital with CPC 1.
Case2: A-66-years-old man became cardiopulmonary arrest(CPA) 45km away from the hospital and the by-stander instantly started CPR. 9 minutes after CPA, the EMS arrived at the scene, the ECG rhythm was ventricular fibrillation(VF). We started ECPR in MOREs 61 minutes after CPA and it took only 13 minutes to establish V-A ECMO. ECMO was successfully discontinued. But he died at day 7.
Case3:A-age-unknown man suddenly became CPA 48km away from the hospital and the by-stander started CPR. 10 minutes after CPA, the EMS arrived at the scene, the ECG rhythm was VF. We started the ECPR 62 minutes after CPR and established V-A ECMO after 84 minutes. But the spontaneous circulation didn’t return.
Conclusion: Prehospital ECPR in MOREs can shorten the time to restart circulation when it takes a lot of time to transfer the patient to the hospital.It was unsuccessful to the CPA patients 45km away from the hospital but successful to the patients 10km away from the hospital. Further research is necessary to decide the adaptation of the ECPR in MOREs according to the distance from the hospital.