Crossing-borders: Experience with International ECMO transports

Abstract

Abstract Background Extracorporeal oxygenation membrane (ECMO) represents the last resort support for patients with cardiac and/or respiratory failure refractory on conventional intensive care. Availability of this highly specialized method for life support is limited to regional centers, and thus, patient transport is needed. Few centers offer mobile ECMO services and experience in international ECMO transports is limited. Aim: The objective was to present our department’s experience on international ECMO transports. Material and methods: We retrospectively reviewed medical records of all international ECMO transports performed from January 1998 to 2022. Results Of 1277 ECMO transports, 357 (28%) were international. In 185 (52%) cases the transport was determined to ECMO Centre Karolinska. Ninety-three (26%) were dispatched from our center or directly from referring Swedish hospital to center abroad due to the lack of beds at our unit, 42 (12%) were transferred between two different centers abroad crossing at least one border, and 33 (9%) between two units within the same foreign country. Seventy-nine percent of the patients were cannulated by our team at the referring hospital, and 63% were supported with venoarterial ECMO. Neonatal transport constituted 46%, pediatric 22%, and adult 32%. Fixed wing aircraft was utilized in 89%, military aircraft carrier in 6.2%, helicopter in 3.9%. The average transport distance was 1200 km (range 160-13530 km), and average time on transport was 4.8 h (range 2-27 h). Hospital survival in the group of patients transferred to our unit was 82%. In 36% of the transports, complications occurred. No deaths occurred on transport. Conclusions International inter-hospital transports on ECMO can be safely performed. Albeit occurrence of adverse events, the risk of mortality is very low. For safe transport, the team must be well trained, be highly competent in intensive care, ECMO physiology, cannulation, intensive care, and air transport medicine.