On-site implantation of a ventricular assist device to facilitate aeromedical transport.
Experiencing an acute coronary event in a remote or community hospital can be fatal, particularly if the event is complicated by cardiogenic shock. Many remote and community hospitals do not have adequate resources to support such a compromised patient. Extrapolating from the domestic hub-and-spoke model, presently used between academic tertiary care facilities and community hospitals, we outline the implementation of such an ad hoc arrangement between Panama (spoke) and South Florida (hub). We transported a team of cardiovascular experts from Florida to Panama, in tandem air ambulances (to limit mandatory crew rest time), to implant a left ventricular assist device (LVAD) in a patient in cardiogenic shock refractory to mechanical/pharmacological support. The low profile LVAD inserted percutaneously by the American team stabilized the patient (a U.S. citizen on assignment in Panama), enabling his air ambulance transport back to South Florida. In this first-of-a-kind report, we outline the challenges and logistics involved in the planning, resuscitation, and aeromedical transport of a patient who was discharged from the hub hospital in Florida after just 30 d.