Aeromedical Transport With Combined Extracorporeal Circulatory and Renal Support Bridging a Critically Ill Patient to Heart Transplantation

Long-distance aeromedical transport of critically ill patients is an increasingly important component of modern intensive care. However, the combination of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and renal replacement therapy (RRT) during an intercontinental flight had never been previously documented. This case report describes the first known case of a 27 year old patient with fulminant viral myocarditis and multi-organ failure who was successfully repatriated from Bangkok (Thailand) to Paris (France) while receiving both VA ECMO and 6 hours of in-flight sustained low-efficiency dialysis (SLED). This unprecedented 10,000 km mission illustrates both the feasibility and the life-saving potential of highly specialized mobile critical care in bridging patients to advanced therapies such as heart transplantation.