Pediatric Extracorporeal Membrane Oxygenation Reach-Out Program: Successes and Insights

Abstract

The shortage of dedicated pediatric extracorporeal membrane oxygenation (ECMO) centers and the expanding indications for pediatric ECMO necessitate a regional program for transport of ECMO-supported patients. Data about feasibly and safety of pediatric ECMO transport are scarce. Our aim is to describe our experience with a pediatric ECMO reach-out program and review pertinent literature. Demographic, clinical, and outcome data were collected retrospectively from the charts of all patients cannulated onto ECMO at referring centers and transported to our center from 2003 to 2018. Similar data were recorded for patients who were referred for ECMO support from within the hospital. The cohort included 80 patients cannulated at 17 referring centers. The transport team included a senior pediatric cardiac surgeon and an ECMO specialist. All transfers but one were done by special emergency medical service ambulance. No major complications or deaths occurred during transport, and all patients were stable upon arrival to our unit. Mortality was lower in the ECMO reach-out cohort than in-house patients referred for ECMO support. This is the first study from Israel and one of the largest to date describing a dedicated pediatric ECMO transport program. Extracorporeal membrane oxygenation transport appears to be feasible and safe when conducted by a small, highly skilled mobile team. Successful reach-out program requires open communication between the referring physician and the accepting center. As survival correlates with ECMO volume, maintaining a large ECMO center with 24/7 retrieval capabilities may be the best strategy for pediatric mechanical circulatory support program.

Pediatric Extracorporeal Life Support Transport in Western Canada: Experience over 14 years

“…The number of crew members in specialized ECLS transport teams has been variable, ranging from 3 to 7. 1,[21][22][23]26,32 Adult ECLS transport teams can potentially manage with fewer team members, with percutaneous cannulation being performed by the transport physician. However, cannulation of pediatric patients, especially those with congenital heart disease and previous surgeries, may be challenging even for a pediatric general surgeon.…”

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

“…Our ECMO transport volumes are low, yet the transport outcomes are similar to the centers with higher ECMO transport rates. 3,5,6,[9][10][11]24 All 26 patients survived while on ECMO transport. We evaluated the survival to discharge rates for this population.…”

“…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.…”

“…The successful transport of a patient on extracorporeal membrane oxygenation (ECMO) was first reported in 1986 by Cornish et al 1 Over the years, many large ECMO transport programs have presented their data on successful patient transports. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, due to the increased anticipated risk of ECMO transport, the regional referral centers with a low-volume ECMO transport census may reconsider the patient acceptance. In this study, we present our 20 years' experience as a low-volume ECMO transport census from the Southeast United States.…”

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.…”