Outcomes of Patients Undergoing Interfacility Extracorporeal Membrane Oxygenation Transfer Based on Cannulation Location and Mode of Transport

Abstract

OBJECTIVES: As the use of extracorporeal membrane oxygenation (ECMO) expands, so has the need for interfacility transfer to ECMO centers. However, the impact of these transfers has not been fully studied. This study evaluates complications and inhospital mortality in adult patients treated with venovenous (V-V) ECMO based on institutional location of cannulation and mode of transport. DESIGN: Retrospective cohort study. SETTING: Large midwestern ECMO center. PATIENTS: Adult patients receiving VV-ECMO. INTERVENTIONS: Need for transfer to ECMO center following VV-ECMO cannulation. MEASUREMENTS AND MAIN RESULTS: The study included 102 adult patients, 57% of which were cannulated at an outside institution prior to transfer. Of these, 60% were transported by ground, and the remainder were transported by air. Risk-adjusted logistic regression did not reveal any significant increase in odds for any complication or inhospital mortality between the groups based on location of cannulation or mode of transport. CONCLUSIONS: This study supports the practice of interfacility ECMO transfer with no difference in outcomes or inhospital mortality based on institutional location of cannulation or mode of transport.

Outcomes of Interfacility VV-Extracorporeal Membrane Oxygenation Transfers: A Multicenter Study

“…This contradicts a single center study previously published from our region. 6 This could be explained by differences in patient selection. Patients transported by air were often from out of state or rural areas and increased travel distance meant that these patients were likely at lower risk of complications before being accepted for transfer.…”

“…Previous studies have examined the survival rate of patients transported on ECMO versus in-house cannulation and have found no significant difference in the two patient populations. [6][7][8][9] With the caveat of studies finding comparable survival rates, clinically relevant details occurring during, or as a consequence of, transport remain poorly elucidated. 8 Complication rates during transport are highly variable with a reported range of complications from 0% to 31.7%.…”