Primary transport on extracorporeal membrane oxygenation: Two Indian center experience

Abstract

Aims: Extracorporeal membrane oxygenation (ECMO) can be a lifesaving modality for patients with severe reversible pulmonary and/or cardiac failure, but its use remains restricted to a few highly equipped referral centers. Conventional transports to an ECMO center can be hazardous. Transport teams are usually trained to transfer stable patients across hospitals. As ECMO patients are extremely sick, specially trained critical care teams to deal with all possible complications in these critically ill patients will be required. Therefore, many ECMO centers have developed transport programs with the mobile ECMO team. In this study, we aim to present a brief account of the two-center experience of ECMO transport from India. Methods: Retrospective observational study is depicting the data of two mobile ECMO teams over 4 years, where 21 patients (16–74 years) were evaluated. Analysis was done for the transport arrangements, different characteristics of ECMO retrieval patients, their outcomes, and predictors of mortality of a total of 21 patients from two different referral centers of India. As it is a retrospective observational study, hence institutional ethical committee approval was waived off. Results: The mean distance of travel was 87.24±104.5 km (range 2–250 km) and transportation was by road in all cases. About 38% (n=8/21), patients had suffered from complications during transport like hypotension, cardiac arrest. There were no deaths in connection with transportation. The overall mortality rate was 33.3% with no difference over gender, age, duration of pre-ECMO ventilation, or duration of transport. The most common indication associated with ECMO transport was H1N1 infection. Conclusion: We found that patient transfer if done with proper protocols by a prepared team with full knowledge of problem areas to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients.