Transport of Patients Supported by Extracorporeal Membrane Oxygenation: An International Qualitative Analysis

Abstract

Objectives

Extracorporeal membrane oxygenation (ECMO) is a form of complete cardiopulmonary support that has been associated with improved survival in severe acute respiratory failure and refractory cardiac arrest. Current data provided by the Extracorporeal Life Support Organization demonstrate that the use of ECMO is increasing. However, ECMO remains a highly specialized and resource-intensive intervention with improved outcomes associated with higher ECMO center volumes, supporting the creation of regionalized care models. As such, the role of critical care transport is vital. Presently, there is little known about methods, crew configurations, protocols, and training for ECMO-capable transport teams. We aimed to descriptively analyze established ECMO transport programs across multiple countries.

Methods

A standardized, 27-item survey was distributed to 16 transport organizations across nine different countries. The survey included items such as transport team composition, training requirements, transport method, and various technical aspects. If available, transport organizations provided ECMO transport protocols and transport configuration schematics.

Results

To date, twelve ECMO programs responded from five countries (75% response rate). Most programs (83%) offer ground, 67% offer rotor-wing, and 50% offer fixed wing transport. A minority of programs (25%) were capable of any method of transport. Nearly half (42%) of programs did not require a separate ECMO team. A physician was present always or variably during ECMO transports in 67% of programs, and 92% of transport teams had a perfusionist or ECMO specialist and a nurse. All twelve programs required initial team ECMO training, and most programs also provided continuing education on an annual basis. Of the nine transport teams capable of performing ECMO cannulation, four programs (44%) could cannulate in any prehospital or in-hospital location.

Conclusions

Critical care transport teams play an essential role in increasing access to ECMO for patients with severe cardiopulmonary failure. There is significant variability in team composition and specialization as well as transport modality, but training requirements are commonly seen across programs. Further study is needed to define the optimal components for safe interfacility transport of ECMO patients.