Transport of a patient with acute respiratory distress syndrome (ARDS) is a crucial problem. A 17-year-old severe hypoxemic woman was transported successfully using mobile extracorporeal lung assist (mobile ECLA). The patient was injured in a massive landslide and admitted to a municipal hospital far about 103km away from our hospital. On admission, a right tension pneumothorax, hemothorax, 2-7 rib fractures and pulmonary contusion were diagnosed. Although intensive therapies were performed, ARDS developed and her oxygenation deteriorated on the 5th hospital day. Arterial oxygen tension (PaO2) was 35 mmHg with a fractional inspired oxygen (FIO2) of 1.0 and a positive end-expiratory pressure (PEEP) of 8cmH2O. After the initiation of veno-venous ECLA with a centrifugal pump, her PaO2 increased to 232mmHg. She was successfully transported under mobile ECLA during the 2.5 hour transport from the municipal hospital to our ICU. We believe that mobile ECLA is a useful method for inter-hospital transport of a patient with ARDS. To our knowledge, this may be the first case of long distant inter-hospital transport on mobile ECLA in Japan.
We encountered a case of sinus arrest in a patient with total paresis at the C4 level associated with dislocation of the 5th cervical vertebra. Sinus arrest was noted on postinjury days 5, 13 and 21. Transthoracic pacing and transvenous pacing were performed to treat the sinus arrests. Artificial cardiac pacing was terminated and Holter ECG was started on postinjury day 35. Sinus arrest was not noted after day 35. Bradycardia attributed to parasympathotonia was considered the cause of the sinus arrest. Although temporary pacing is not useful in treating sinus arrest which occurs only once or recovers after a few seconds, it should be used in cases of recurrent sinus arrest or sinus arrest which persists for more than 1 minute. Furthermore, intensive continuous monitoring for more than a month including ECG is recommended in patients with cervical spinal cord injuries.