Mobile ECMO – A divine technology or bridge to nowhere?

Abstract

Extracorporeal life support emerged as a salvage option in patients with therapy-refractory severe hemodynamic or respiratory failure. However, this promising therapy option has been limited by the use of experienced teams in highly specialized tertiary-care centers. Thus, in order to provide this standard of care in local hospitals and due to increasing evidence on improved outcomes using ECMO devices and setting for patients with heart and lung failure, an increasing number of experienced ECMO centers have launched mobile ECMO retrieval services in recent years. Areas covered: This review provides a summary on the current scientific status concerning use, indications and complications of mobile ECMO devices and services. A scientific literature research was conducted in MEDLINE, Embase, Cochrane and Web of Science databases using keywords denoted. Expert commentary: Mobile ECMO devices and setting offer severely ill patients refractory to maximal conventional treatment an option of hemodynamic and/or respiratory stabilization and subsequent transportation to specialized care centers for further treatment. Compared to in-hospital ECMO support, out-of-hospital mobile ECMO implantation, transport and retrieval of patients require additional organizational, logistical and clinical efforts. This review provides a summary on the current scientific status concerning use, indications and complications of mobile ECMO services.

Emerging concepts in heart failure management and treatment: circulatory support with extracorporeal membrane oxygenation (ECMO)

“…catheterization laboratory, cardiac intensive care units, emergency department, and even out-of-hospital cardiopulmonary resuscitation (CPR)). 8 – 10 …”

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

“…80,82 Through initial experiences by mobile ECMO teams, data are emerging on the profile of patients who will benefit more from mobile ECMO: younger patients (<60 years); patients with no flow time of fewer than 5 minutes; and patients with a shockable rhythm, sufficient CPR, and ECMO implantation time of 60 minutes. 82,84 There are also case reports and reviews describing the use of ECMO for temporary circulatory support during procedures such as ventricular tachycardia ablation, percutaneous valve replacement, and resection of a thoracic mass. 85À88 Also described is the use of VA-ECMO to optimize patients with advanced structural heart disease before proceeding with surgery.…”

Similarities in extracorporeal membrane oxygenation management across intensive care unit types in the United States: An analysis of the Extracorporeal Life Support Organization Registry

“…As such, there is robust literature specific to its role in cardiac surgery and the cardiothoracic ICU (CTICU) 17,18 . Recent descriptions show a wide array of use beyond the paradigm of postcardiotomy shock in the CTICU as demonstrated by the advent of specialized respiratory ECMO units, mobile ECMO teams, and multidisciplinary shock teams 1–13,19–22 . It is unknown how expanding indications and novel/non‐CTICU locations may affect the delivery of ECMO given this historical context.…”

“…17,18 Recent descriptions show a wide array of use beyond the paradigm of postcardiotomy shock in the CTICU as demonstrated by the advent of specialized respiratory ECMO units, mobile ECMO teams, and multidisciplinary shock teams. [1][2][3][4][5][6][7][8][9][10][11][12][13][19][20][21][22] It is unknown how expanding indications and novel/non-CTICU locations may affect the delivery of ECMO given this historical context. Importantly, the hospital units where ECMO initiation and maintenance occur have increasingly included non-CTICU locations (i.e.…”