# The challenge of advanced therapies in the contemporary era: first in Europe ECPELLA long-distance transfer—a case report

## TL;DR

This case report details the first long-distance air transfer in Europe of a patient on advanced heart support, leading to a successful heart transplant.

## Contribution

The first documented long-distance air transfer in Europe using ECPELLA as a bridge to heart transplant.

## Key findings

- A patient with advanced heart failure was successfully transferred over long distance on ECPELLA support.
- The transfer was followed by a successful heart transplant and stable recovery over 12 months.
- Proper planning and multidisciplinary coordination are critical for such complex transfers.

## Abstract

The use of mechanical circulatory support (MCS) has markedly increased over the last decade, so have the inter-hospital transfers, with the aim of being able to offer advanced heart failure (AHF) therapies and centralizing patients to tertiary centres.

In this article, we present the first in Europe long-distance air transfer of a patient supported by veno-arterial extracorporeal membrane oxygenator and Impella (ECPELLA), as a bridge to successful heart transplant. In our case report, a foreign young patient with AHF due to familiar cardiomyopathy required multiple MCS devices to achieve cardiovascular stability. After appropriate planning and multidisciplinary discussion, the patient was transferred on MCS to his country of origin via a fixed-wing airplane, in order to be assessed for heart transplantation. During take-off, the Impella flows temporarily dropped and a suction alarm was displayed; however, this rectified without intervention, and the rest of the flight was uneventful. One month after transfer, the patient underwent successful heart transplantation and remained clinically stable during the 12-month follow-up.

Our experience links together the current challenges in the evolving AHF strategies and the increased need for inter-facility cooperation. Both these clinical and logistic challenges appear to lead to possible improved outcomes, after appropriate assessment, training, and accurate planning. Our experience provides useful information on feasibility of long-distance transport of patients supported by ECPELLA in Europe.