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#1 SerendepitySaki

SerendepitySaki

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Posted 14 February 2010 - 02:58 AM

some parsing issues from acrobat....please see WayPoint AirRescue Magazine 14

Novalung first for FAI


Thomas Buchsein of fixed-wing air ambulance provider Flight Ambulance International (FAI) reports on the company's first use of Novalung technology

The letters ARC'S (acute respiratory distress
syndrome) and All (acute lung injury) stare for
the most severe types of respiratory failure, which
are a common clinical appearance and the often
lethal common path of a variety of diagnoses such
as pneumonia (including all types of infJuenzaassociated
chest infections), severe multiple
trauma arc septic shock. Striving always to be at
the frontier of mobile intensive care mecicire,
FAI used the Novalung iLA (interventional lung
assist) Membrane Ventilator for the first time, a
new extracorpora! 'artificial lung' technology, to
assist conventional mechanical ventilation in ARDS
patienrs arc to prevent the often irreversible lung
tissue damage that is typically associated with
aggressive mechanical ventilation strategies.
The system is characterised by a low-resistance
membrane, wNch is integrated in an artificial
arterio -venous bypass. Driven by the patient's
own blood pressure (thus independent of
any mechanical pump and power source),
the bloodfbw is shunted from the cannuiised
femoral artery to the also-can nuliseo femoral vein
through a small ('. 4x; 4 cm) plastic box, containing
the core of the system: the aforementioned
sophisticated gas-exchanging, heparin-coated
hollow-fibre diffusion membrane, which does what the patients lungs fail to do - removing carbon oioxice anc adding oxygen to the blood.

Our first mission with the new system took us
to Kuwait, where we had been asked not only
to transport a patienc. but also to assist the local


medical team with a ven/ challenging intensive
care and mechanical ventilation. The patient was
a 52-year old technical engineer with ARDS
subsequent 10 severe bilateral pneumonia and
sepsis. From our preflight assessment, we were
already aware that chest X-rays showed a 'white
lung' and that the ventilator was already set to a
very high oxygen concentration of 90 per cent
and a PEEP (peak end-expiratory pressure) of ! 5
mmHg, parameters that wouid normally dearly
forbid any air transport.


The FAI medical team (Dr Gotz Leonhard,
deputy chief medical officer, and Simon Obier
chief paramedic) was for this particular mission
supplemented by Bemd Resio, a very helpful
Novalung Medea! Technician and 'rained
intensive care unit nurse.
After the usual general patient assessment. Dr
Leonh-ardt performed a Doppler-u-ltrasound
examination, ro locate and measure che
inguinal vessels before successfully cannulising
them. He then connected the iLA-membrane
box anc opened the arterio-venous shunt
through the iLA-box in which gases and blood
are separated only by the aforementioned
low-resistance diffusion membrane, analogous
to the natural lung. During the following hours,
it -was possible to gradually adjust the respirator
towards lung protective parameters without
the limitations usually imposed by the need for
pulmonary gas exchange. Twenty -four hours
later, the patient was considered stable enough
to take him onboard. The flight was conducted
at the standard cabin pressure of 7,5)00 ft
without any adverse effects - pulsoxymetry,
capnometry and blood gases remained stable
throughout the flight.


Summary
The Novalung Membrane Ventilator is a
lightweight, low-cost, easy-to-use pumpiess (driven
by the palients cardiac output) pulmonary assist
device, clinically already well established in patients
with acute lung failure. \~ is now entering the world
of aeromedical transport as a new and promising
asset in helping our patients io survive.





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