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

Abstract

Extracorporeal membrane oxygenation (ECMO) support requires skills that can only be found in specialized centers. The number of patients annually supported with ECMO is positively associated with the survival rate, so transport to a specialized center is recommended. 1 Some patients are too ill to be transferred under conventional transport (mechanical ventilation/vasoactive drugs), so they must be transferred on ECMO.Cannulating the patient at the referring hospital and transporting on ECMO was first described by Bartlett et al. 2 ; since then, a large number of ECMO transports have been described. Mobile ECMO for pediatric patients combines specificities of hemodynamic management of a low-weight patient with transportation's technical issues, and currently, there is a paucity of reported data of indications, processes, and outcomes of pediatric ECMO transport [3] . To our knowledge, in Latin America, pediatric ECMO transport is only available in Brazil, Colombia, Mexico, and Chile, and no reports have been published. Our institution implemented Mobile ECMO in March 2007, and the first pediatric ECMO transport was carried out in July 2011.We retrospectively reviewed our institutional database of all patients ≤18 years old who were transferred on mobile ECMO. The institutional review board approved the study.Requests for mobile ECMO were initiated by the referring physician calling by phone to an ECMO-team pediatric intensivist to evaluate 1) the referral indication, 2) the eligibility to ECMO support according to ELSO Guidelines, [4][5][6] and 3) the chance to improve the local management avoiding the use of ECMO when not necessary. Patients were eligible for respiratory ECMO if they had a severe, refractory, potentially reversible hypoxemic or hypercapnic respiratory failure and met any of the following criteria: oxygenation index >30, PaO 2 /FiO 2 ratio less than 100 despite maximal medical therapy (prone positioning, fluid restriction, NO, neuromuscular blockade, high-frequency oscillatory ventilation [HFOV]), hypercapnia, From the