Berlin Heart EXCOR Ventricular Assist Device

Transcription

1 First transportation on a Berlin Heart LVAD as a bridge to transplantation to Arkansas Children s Hospital Dorothy Garbin, CCP Berlin Heart EXCOR Ventricular Assist Device Pediatric pulsatile assist device Univentricular or biventricular support Long term support of the circulatory function Native heart to recover Bridge to transplantation Variety of sizes Stroke volumes ranging from ml Patients from neonates to older teenagers

2 Berlin Heart EXCOR Ventricular Assist Device Two chambers Flexible membrane Push/pull action of the IKUS Pulsatile blood flow, which mimics normal heart function Air side Attached to a drive unit Alternating positive and negative pressure to push and pull blood Blood side Attached to the patient s heart via cannulas and isolated by a series of one way valves Berlin Heart EXCOR Ventricular Assist Device RVAD Right Atrium to Pulmonary artery Right ventricle to Pulmonary artery Not common practice LVAD Left ventricle to Aorta Left atrium to Aorta Not common practice

3 Clinical Case 3 yr old girl was taken to Children s Hospital in New Orleans, Louisiana Normal cardiac anatomy Severely depressed heart function Abnormal rhythms Viral myocarditis/cardiomyopathy ECMO 8 days, no improvement Left Ventricular Assist Device 30 ml Berlin Heart EXCOR LVAD pump Transportation Planning Team: Cardiologist with experience in mobile ECMO Perfusionist with Berlin VAD experience Transport team member with ECMO transport experience

4 Transportation Planning Test run Reviewed data from transports at other centers Berlin IKUS Ambulance Aircraft Mechanics Electrical supply Troubleshooting Complications on with other Berlin transports Transportation Planning

5 Transport Transport IKUS was left on board the aircraft Local IKUS was transported with the patient and team back to the aircraft Patient was switched over to the transport IKUS and lifted into the aircraft Disconnected for 3-5 seconds Transport

6 Transport Closely monitored Vitals remained stable Hemodynamics Patient 1 Heart Rate (beats/min) 143 ± 8 Mean BP (mmhg) 87 ± 4 Systolic BP (mmhg) 112 ± 7 Diastolic BP (mmhg) 77± 4 Respiratory Respiratory Rate (resp/min) 39 ± 11 SpO2 (%) 97 ± 3 Respiratory Support Room Air Transport Moisture build-up In the cabin Plans were made for alternate power sources On the IKUS unit Hand-pumping if necessary

7 Other Transportations American girl from Denver, Colorado Marseille, France to a local hospital in Denver Two others transported within the United States Children s Hospital of Pittsburgh Discussion Drawing on our experience with mobile ECMO Aware of several technical issues Team preparation including planning and practicing Practicing with the exact equipment Moving the stretcher Turning the IKUS on and test the generator Measuring the length of the drive line tubing An adequate power source

8 Conclusion Pediatric Berlin VAD transports are rare There is not much information available Future flights Future Direction Mobile IKUS Allowing the patient to board and deplane with little assistance Can detect and measure ambient pressure Allowing the internal controller to work with changing pressures

9 Questions or Comments? References Berlin Heart. (2009). EXCOR Pediatric VAD Rev Berlin Heart Inc, pp , 18. Duncan, B.W. (2006). Pediatric mechanical circulatory support in the United States: Past, Present and Future. ASAIO J, 52, pp Flynn-Thompson, F., Almond, C. (2007). Pediatric ventricular assist devices. Pediatric Cardiology, 28, pp Hanchey, L. (2012, August 21). First Berlin Heart Implanted in Three-Year-Old. Louisiana Medical News. Retrieved from: Hetzer, B., Stiller, B. (2006). Technology insight: Use of ventricular assist devices in children. National Clinical Practice Cardiovascular Medicine, 3, pp Imamura, M., Dossey, A., Prodran, P., Schmitz, M., Frazier, E., Dymenahalli, U., Bhutta, A., Morrow, R.W., Jaquiss, R.D.B. (2009) Bridge to Cardiac Transplant in Children: Berlin Heart verus Extracorporeal Membrane Qxygenation. The Annals of Thoracic Surgery, 87, pp doi: /j.athoracsur Tissot, C., Buchholz, H., Mitchell, M., Cruz, E., Miyamoto, S., Pietra, B., Charpentier, A., Gher, O. (2010). First pediatric transatlantic air ambulance transportation on a Berlin Heart EXCOR left ventricular assist device as a bridge to transplantation. Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 11, e doi: /pcc.0b013e3181bc5974 Unkel, K. (2011, March 31). Successful transatlantic EXCOR air ambulance transportations. OpenPR Worldwide Pulbic Relations. Retrieved from: http//: