Aeromedical transport of patients receiving extracorporeal membrane oxygenation: a 12-year experience from a regional mobile ECMO network in the French Caribbean.

Abstract

Background: The use of extracorporeal Membrane Oxygenation (ECMO) increases for patients with refractory cardiac and/or respiratory failure. To ensure broader access to this life-saving therapy, regional ECMO networks have been developed worldwide, enabling the transfer of patients supported with ECMO to specialized referral centers. At the University Hospital of Martinique, a Mobile Circulatory Support Unit provides 24 h/7 coverage for inter-hospital aeromedical transport of patients receiving ECMO across the French Departments of the America and to mainland France. This study aimed to describe the characteristics, transport modalities, and transport-related adverse events of patients undergoing ECMO-supported aeromedical transfer within this regional mobile ECMO network, as well as their short-term and in-hospital outcomes.

Methods: We conducted a retrospective, observational, single-centre study including patients who underwent ECMO-supported aeromedical transfer coordinated by the Mobile Circulatory Support Unit and Emergency Medical Service between January 2010 and December 2021. We collected data on patient characteristics, ECMO configuration and indication, transport modalities, transport-related adverse events, and short-term and in-hospital outcomes.

Results: Of the 520 patients supported with ECMO during the study period, only the 126 who underwent aeromedical evacuation were included in the analysis, including 87 intra-Caribbean and 39 transatlantic transfers. Patients were predominantly male (61.1%), with a mean age of 43 [29.25-56] years, and at least one comorbidity present in 60.3% of cases. Veno-venous ECMO was predominantly used for intra-Caribbean transfers (80.5%), mainly for acute respiratory distress syndrome, whereas veno-arterial ECMO for refractory cardiogenic shock predominated in transatlantic transfers (87.2%). In-transfer complications occurred in 18.3% of cases and were mainly related to hemodynamic instability, with one transport-related death reported. Overall in-hospital mortality was 54.7%, with no significant difference between intra-Caribbean and transatlantic patients.

Conclusion: Aeromedical transport of critically-ill patients under ECMO support appears feasible and relatively safe in our experience, with a low incidence of serious adverse events. The high in-hospital mortality reflects the acute cardiac and/or pulmonary failure, as well as the burden of comorbidities in this population. Prospective studies using standardized adverse-event collection are needed to more accurately evaluate transport-related risks and longer-term outcomes in this high-risk population.