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International Waterway E60 (IWW E60) is a sea-shore route running from Gibraltar to the North along European coast up to St. Petersburg then through the Baltic-White Sea Channel, then along the White Sea coast to Arkhangelsk. From the German-Polish border, along the Polish, Russian and Lithuanian coast to the Lithuanian-Latvian border, the route is 610 km-long and runs along 32 Polish municipalities and 4 Lithuanian regions. Determining the role of IWW E60 is important in the context of economic growth of municipalities and coastal regions, especially through the development of local seaports. Operations of the multifunctional port have a wide economic and social impact. Mutual interaction of functions can be observed on the example of fisheries, where in the port area fishing functions intermingle with the processing, tourism, storage and distribution function. The main socioeconomic benefits of E60 waterway development include the increase in employment, economic activity, generation of added value and improvement of transport infrastructure. In addition, ports influence attractiveness of the regions and create impulse for new jobs in the tourism industry. Until now there have been no attempts to make E60 route navigable or only on short sections, usually between two neighbouring ports. Despite the significant cross-border importance of this connection, no directions for its optimal development were defined. What is more, the route is not used. In connection with this, steps were taken to thoroughly investigate the problem and determine the possibility of its development as part of inland waterways network.

Background: The recent outbreak of AH1N1 influenza was associated with an increased number of respiratory complications. There were some extremely severe cases of ARDS, in which conventional therapy could not secure adequate gas exchange. These patients fulfilled ECMO criteria, however, due to late referral, were not suitable for transportation. To solve this problem, a portable ECMO system, providing for safe management of these patients, has been introduced in our institution., Case Report: We reviewed five adult ARDS patients, who were transported by an ambulance for a distance ranging from 2 to 95 km, over 35 to 120 min. In four cases, a veno-venous ECMO system was used, and one patient had an arterio-venous circuit. All circuits were implanted before transportation by a dedicated team from the reference hospital, comprising an anaesthesiologist, a cardiac surgeon and a perfusionist. All transportations were successful and no complications and/or technical problems were observed. During the subsequent ITU treatment, three patients survived and two died (one because of uncontrollable bleeding from the ECMO cannula, and one because of sepsis and multiple organ failure)., Conclusion: We conclude that safe use of ECMO during transportation is possible, and does not require very sophisticated and expensive equipment. A standard ambulance is sufficient for the purpose.

Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed.