Mobile extracorporeal membrane oxygenation for children: single-center 10 years’ experience

Abstract

Objectives: Extracorporeal membrane oxygenation has become a gold standard in treatment of severe refractory circulatory and/or pulmonary failure. Those procedures require gathering of competences and material. Therefore, they are conducted in a limited number of reference centers. Emergent need for such treatments induces either hazardous transfers or a mobile pediatric extracorporeal membrane oxygenation team able to remote implantation and transportation. The aim of this work is not to focus on pediatric extracorporeal membrane oxygenation outcomes or indications, which have been extensively discussed in the literature. This study would like to detail the implementation, safety, and feasibility, even in a middle-size pediatric cardiac surgery reference center. Patients: This is a retrospective analysis of a series of patients initiated on extracorporeal membrane oxygenation in a peripheral center and transferred to a reference center. The data were collected from 10 consecutive years: from 2006 to 2016. Results: A total of 57 pediatric patients with a median weight of 6.00 (3.2-14.5) kg and median age of 2.89 (0.11-37.63) months were cannulated in peripheral center and transported on extracorporeal membrane oxygenation. We did not experience any adverse event during transport. The outcomes were comparable to our literature-reported on-site extracorporeal membrane oxygenation series with 42 patients (74%) weaned from extracorporeal membrane oxygenation and a 30-day survival of 60%. Neither patient’s age nor weight, indication for extracorporeal membrane oxygenation or length of transport, was statistically significant in terms of outcomes. Conclusion: Offsite extracorporeal membrane oxygenation implantation and ground or air transport for pediatric patients on extracorporeal membrane oxygenation appeared to be safe when performed by a dedicated and experienced team, even within a mid-size center.

ECMO Transport without Physicians or Additional Clinicians

“…These studies are often based at ECMO centers where the majority of transports begin with a mobile team that deploys to cannulate the patient at a referral hospital. 16,18,19,[23][24][25] The patient is then transported on ECMO back to the tertiary care center for further management. This type of transport is designated as a "primary" transport.…”

Safety of Interhospital ECMO Transport by Low-Volume ECMO Transport Centers

“…Most other published reports on ECMO transport are from programs with much higher rates than ours. [4][5][6][7]10,13,14,20,21 Hence, we defined our program as a low-volume ECMO transport program comparatively. A dedicated neonatal and pediatric ECMO transport with good outcomes from a low-volume ECMO transport program has not been reported previously.…”

Pediatric Extracorporeal Membrane Oxygenation (ECMO) Transport in a Developing Nation: A Single Center Experience

“…Despite these difficulties, the clinical outcomes of our mobile ECMO program, including survived ECMO, hospital discharge, and 1-year follow-up, are similar to those reported by other authors from high-income countries. 3,7–9 In summary, we report that cannulation of pediatric patients at the referring center followed by transport to an experienced center on pediatric ECMO is feasible and safe when conducted by a highly skilled team, even in lower-income countries with geographic difficulties.…”