Complications and Adverse Events During Primary and Secondary ECMO Retrieval Missions: A Single Center Retrospective Analysis

Introduction

Extracorporeal Membrane Oxygenation (ECMO) can be an effective, lifesaving intervention to rescue the most critically ill patients with severe respiratory and/or circulatory failure. As a result of increased demand and technological advances, the implementation of ECMO as a therapeutic modality has increased significantly. With this proliferation of ECMO, the need to transport these patients to experienced ECMO centers has also increased. These transports, however, are clinically and logistically complicated. Data on the number and nature of complications during transportation of ECMO patients is limited. The aim of this single-center, retrospective analysis was to better quantify and describe complications and adverse events associated with ECMO transportation in a relatively new, multidisciplinary regional ECMO transport program.

Methods

This was a single-center, retrospective analysis of existing quality assurance data as part of routine clinical quality and process improvement measures. The data was reviewed from February 1, 2024 – January 31, 2025. We reviewed missions where the ECMO Transport Team was activated and deployed for ECMO retrieval. Documentation from a structured, standardized debrief form and clinical documentation was reviewed. Adverse events were identified based on the U.S. Department of Health and Human Services definition and in accordance with previously published literature related to adverse events in ECMO transport. These events were then categorized based on type of event including adverse events related to the ECMO circuit, other medical equipment, patient specific clinical events, Human Factors (communication, medication errors, etc), and transport operations. Given the time-sensitive nature of these patients’ disease process we also included logistical adverse events that may have delayed care.

Results

30 ECMO Transport Team activations/deployments were reviewed between February 1, 2024 and January 31, 2025. The mission types included 12 (40%) primary ECMO retrieval missions, 13 (43%) secondary transports, 4 (13%) missions where the patient was transported without cannulation, and 1 (3%) mission where no patient was transported. There was 1 death in transport. 25 (83%) transports experienced at least 1 complication, but only 3 (9%) of transports experienced a severe complication or adverse event that resulted in significant and immediate risk to the patient. The median complication/adverse event score was 2, the average was 3.2 (SD 9.2).

Conclusions

Complications and adverse events in this cohort of patients with exceptionally high acuity was common. However, most complications were minor and did not present significant risk to patients. Primary and secondary retrieval of these complex patients can be performed safely by a well-trained and coordinated multidisciplinary team.