A Single-Center Experience of 900 Interhospital Transports on Extracorporeal Membrane Oxygenation

Abstract

Background

The dawning of the extracorporeal membrane oxygenation (ECMO)-2 era, with the potential of decentralizing ECMO treatment, has stressed the need for research into the safety of ECMO transportations. The aim of this study was to (1) provide a comprehensive summary of transport arrangements and complications at a high-volume ECMO center, (2) determine predictors of severe complications occurring during transport, and (3) determine transport-related predictors of mortality.

Methods

This was a retrospective population-based observational cohort study of all interhospital ECMO transports performed by the Karolinska University Hospital between 1996 and 2017. Medical records, clinical notes, and original transport protocols were collected and reviewed.

Results

A total of 908 ECMO transports were performed. Neonatal and pediatric patients were more likely to be subjected to international transport, air transport, and longer transport distances and transport times. A severe complication occurred in 20% of transports and was significantly associated with venoarterial ECMO (p = 0.04) and fixed-wing transport (p = 0.01). Severe transport complications were not associated with increased mortality. Two patients passed away during transportation.

Conclusions

Severe complications during ECMO transportation recurrently occurred but did not affect mortality. We conclude that interhospital ECMO transportation is safe, when conducted by an experienced center, and patients should be transported for treatment at a high-volume ECMO center in accordance with the hub-and-spoke model whenever feasible.