Extracorporeal Life Support Organization Guideline for Transport and Retrieval of Adult and Pediatric Patients with ECMO Support

Abstract

Disclaimer: This guideline for the preparation for and undertaking of transport and retrieval of patients on extracorporeal membrane oxygenation (ECMO) is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgement, knowledge and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

Risk of COVID‐19 infection among mobile extracorporeal membrane oxygenation team

“…A total of 63 different mobile ECMO team members were exposed to COVID-19 patients in a total of 199 episodes of Current guidelines also recommend a hub-and-spoke model to better utilize resources and centrcentralizealise this highly demanding service. 22 The risk of transmission of COVID-19 infection to HCWs cannot be underestimated. Globally, nearly 4% of patients reported to be infected with COVID-19 were HCWs.…”

“…Current guidelines also recommend a hub‐and‐spoke model to better utilize resources and centrcentralizealise this highly demanding service. 22 …”

“…Transportation and retrieval on ECMO are challenging and necessitate the implementation of the interprofessional, well‐trained team, checklists, and dedicated equipment. Current guidelines also recommend a hub‐and‐spoke model to better utilize resources and centrcentralizealise this highly demanding service 22 …”

Extracorporeal Membrane Oxygenation: Beyond Conventional Indications

“…The role of extracorporeal membrane oxygenation (ECMO) in Coronavirus 2019 (COVID-19) associated severe acute respiratory distress syndrome (ARDS) has been a subject of debate because of the early negative results [76,77]. Despite that ECMO has been recommended as supportive intervention by multiple societies [78,79]. However, subsequent studies from the extracorporeal life support organization (ELSO) showed that the use of V-V ECMO in COVID-19 is associated with an in-hospital mortality of 36.9-51.9% at 90 days [80,81].…”

“…Clear, closed loop communication is an important aspect throughout. The best method to train the transport team is by conducting simulation scenarios to address the most common complications that could arise [78]. ECMO centers are highly encouraged to develop ECMO transport checklists aimed at minimizing the near misses and reduce human-factor error.…”