The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian “Rete Respira” network

Nardo, Matteo Di; Lonero, Margherita; Pasotti, Elisabetta; Cancani, Federica; Perrotta, Daniela; Cecchetti, Corrado; Stoppa, Francesca; Pirozzi, Nicola; Salvia, Ondina La; Nicolini, Antonella; Amodeo, Antonio; Patroniti, Nicolò; Artigas, Antonio

doi:10.1177/0267659118766829

Cited by 17 publications

(27 citation statements)

References 16 publications

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“…The concept of a mobile ECMO team has been reported either for adults [1,5,7,8,11,[19][20][21][22][23][24][25] and children [9,14,26], and highly successful transportation of patients on ECMO has been described for short and long distances by ambulance, helicopter, and airplane [25,27,28]. As elsewhere stated [1], "each ECMO network should ideally create mobile ECMO teams to retrieve patients and to deal with patients who have critical cardiopulmonary failure refractory to conventional created around tertiary referral hospital with ECMO expertise in the UK [29], Italy [26], and…”

Section: Discussionmentioning

confidence: 99%

The “Hub and Spoke” (Hands) Ecmo for “Resuscitating” Neonates With Respiratory Life Threatening Conditions

Padalino

Doglioni

Nardo

et al. 2020

Preprint

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The neonatal Hub and Spoke (HandS) ECMO approach provides emergent ECMO implantation to support neonates in severe cardio-respiratory life-threatening conditions at secondary (Spoke) centers, and a safe transfer to the ECMO center (Hub). We report a retrospective review of 11 neonates fom January 2014 to January 2020, presenting with life-threatening conditions and treated by HandS ECMO team in Spoke hospitals. Protocols and checklists were arranged by a local group of ECMO experts and shared with all the hospitals located in North-Eastern Italy. At the emergent call, all patients were cared for at the Spoke hospitals, receiving maximal respiratory and cardiovascular support (including high frequency oscillatory ventilation, inhaled nitric oxide, and major inotropic intravenous infusion). All but 3 patients were affected by life-threatening meconium aspiration syndrome. Median duration of ECMO support and hospitalization were 4 days (range 2-32) and 30 days ( range 8-50), respectively. All but 2 patients with congenital diaphragmatic hernia, were weaned off ECMO and discharged home without complications. At a median follow up of 14.4 months (1.3-74.8), all survivors were alive and in good clinical conditions, without medications, and normal somatic growth. All but one had normal neuropsychological development. We conclude that HandS ECMO model for treating neonates in life-threatening conditions is effective and successful. A specialized multidisciplinary team and common organizational protocols shared between Hub and Spoke centers are the key-points for success. While excellent results occur with MAS (100% survival), treatment was not successful in CDH, in which other that HandS ECMO issues are implied. Lessons learned from our experience are presented and discussed in this article.

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Section: Discussionmentioning

confidence: 99%

The “Hub and Spoke” (Hands) Ecmo for “Resuscitating” Neonates With Respiratory Life Threatening Conditions

Padalino

Doglioni

Nardo

et al. 2020

Preprint

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“…Over 10 years, our team did not experience any patient adverse event during transportation, where as the Stockholm experience published by Broman et al 11 in 2015 described 27.3% of adverse events during transport. Recently, Di Nardo et al 9 published data related to their 5 years’ experience of mpECMO. This study focused specifically on 20 pediatric cases with a median age of 35.5 months.…”

Section: Discussionmentioning

confidence: 99%

“…Although feasibility and sustainability of ECMO transports for adults [3][4][5] are largely demonstrated, very few publications are specifically dedicated to neonatal and pediatric population. 1,6,7,8 An Italian study has just been published in 2018 by Di Nardo et al 9 Thus far, there is no implemented mpECMO network in France.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Note, a network need not be restrained by national borders for certain diagnoses, i.e., congenital diaphragmatic hernia (CDH), or by a limited population too low to support a low-incidence high-cost therapy. Transports of neonates and children have been described in both national networks (14, 21, 22) and in networks transcending national borders (13, 23, 24).…”

Section: Introductionmentioning

confidence: 99%

“…This high number may coincide with case mix as well as a high frequency of venoarterial ECMO patients and fixed wing transport, both associated with an increased risk for transport complications (24). In a mixed group of both neonatal and pediatric patients five adverse events were reported in 20 ECMO transports (21). In an attempt to identify adverse events a four-level risk category scale was introduced by Ericsson et al (29), and a revision recently published (24).…”

Section: Introductionmentioning

confidence: 99%

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

Broman

2019

Front. Pediatr.

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In recent years the number of extracorporeal membrane oxygenation (ECMO) cases in neonates has been relatively constant. Future expansion lays in new indications for treatment. Regionalization to high-volume ECMO centers allows for optimal utilization of resources, reduction in costs, morbidity, and mortality. Mobile ECMO services available “24-7” are needed to provide effective logistics and reliable infrastructure for patient safety. ECMO transports are usually high-risk and complex. To reduce complications during ECMO transport communication using time-out, checklists, and ECMO A-B-C are paramount in any size mobile program. Team members' education, clinical training, and experience are important. For continuing education, regular wet-lab training, and simulation practices in teams increase performance and confidence. In the future the artificial placenta for the extremely premature infant (23–28 gestational weeks) will be introduced. This will enforce the development and adaptation of ECMO devices and materials for increased biocompatibility to manage the high-risk prem-ECMO (28–34 weeks) patients. These methods will likely first be introduced at a few high-volume neonatal ECMO centers. The ECMO team brings bedside competence for assessment, cannulation, and commencement of therapy, followed by a safe transport to an experienced ECMO center. How transport algorithms for the artificial placentae will affect mobile ECMO is unclear. ECMO transport services in the newborn should firstly be an out-reach service led and provided by ELSO member centers that continuously report transport data to an expansion of the ELSO Registry to include transport quality follow-up and research. For future development and improvement follow-up and sharing of data are important.

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The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian “Rete Respira” network

Abstract: Neonatal and pediatric ECMO transports can be safely performed with a dedicated team that maintains stringent adherence to well-designed management protocols.

Cited by 17 publications

References 16 publications

The “Hub and Spoke” (Hands) Ecmo for “Resuscitating” Neonates With Respiratory Life Threatening Conditions

The “Hub and Spoke” (Hands) Ecmo for “Resuscitating” Neonates With Respiratory Life Threatening Conditions

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

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

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