International Survey on Extracorporeal Membrane Oxygenation Transport

Abstract

The "10-Q" for review/position paper on how inter-hospital transports on Extracorporeal membrane oxygenation (ECMO) is performed and organized in different health care systems in different parts of the world. How is the suggestion from to the ECMONet (Combes et al 2014) regarding the Hub-and-Spoke model with the larger ECMO centre in the middle who provide the service performing as compared to other models, for example Japan with multiple ECMO centers all doing their own transfers (?), or United Kingdom who transfer to five major hospital for adult ECMO.This study is an investigation planned and designed by the ECMO European Advisory Board (EEAB), an independent consortium for the development and research in all matters related to Extracorporeal membrane oxygenation.

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

“…As recently as a decade ago, only a small number of centers worldwide provided mobile ECMO services for bedside assessment and cannulae insertion. After stabilization, the patient was transported on ECMO for continued support at an ECMO center (13, 14). A transport preceded by bedside assessment, decision, and cannulation for ECMO by direct involvement of the transport team is defined as a primary transport (14, 15).…”

“…After stabilization, the patient was transported on ECMO for continued support at an ECMO center (13, 14). A transport preceded by bedside assessment, decision, and cannulation for ECMO by direct involvement of the transport team is defined as a primary transport (14, 15). A secondary transport is a transfer of a patient already on ECMO, often for a day or more, i.e., the mobile team was not directly involved in the cannulation procedure.…”

“…In the future, however, these units may serve as support centers in larger clinical ECMO networks. One example of this, the Hub-and-Spoke model, has already been implemented in various health care systems (14, 19, 20). For these to be effective, a “24-7” on-call transport service is needed that provides both primary and secondary transports.…”

“…Note, a network need not be restrained by national borders for certain diagnoses, i.e., congenital diaphragmatic hernia (CDH), or by a limited population too low to support a low-incidence high-cost therapy. Transports of neonates and children have been described in both national networks (14, 21, 22) and in networks transcending national borders (13, 23, 24).…”

“…Most importantly, we need to know more about transport related adverse events, how these should be best managed or avoided, and how they correlate to short- and long-term morbidity and mortality outcomes. ECMO transports are unregulated in most countries (14), and authorized transport programs are sparse. Only a handful of publications are based on large numbers of transports (13, 24–26).…”