title: Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation--national and international experience.
abstract: OBJECTIVE
  To evaluate the experiences and results from inter-hospital transportation of patients with acute respiratory failure on extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Observational, descriptive study.
  
  
  METHODS
  Tertiary referral center in a University Hospital.
  
  
  METHODS
  When standard ECMO criteria were fulfilled and the patient considered too unstable for a conventional transport, the mobile ECMO team cannulated the patient for ECMO at the referring hospital. The patients were then transported to our ECMO center by ground ambulance, helicopter or fixed-wing vehicle. Patients were also transported on ECMO from our ECMO center to other centers due to shortage of available ECMO beds.
  
  
  RESULTS
  29 patients (15 neonates, seven pediatric, and seven adult patients) with acute respiratory failure were transported on ECMO on a total of 30 occasions. Median time from arrival of the ECMO team at the referring hospital until the patient was on ECMO (28 patients) was 2.2 h (range 1.25-4.25 h). The median time that the transport team was out was 10 h (range 5.5-36.5 h) and the median time with the patient was 6 h (range 3-30.5 h). The distance of transport ranged from 4-1,500 km. Six transports were international. No patient complications occurred during the transports. Two technical complications related to the transport vehicle were encountered. One ambulance compressor malfunctioned. During one helicopter transport, one out of two electric supply circuits malfunctioned. The patients were not affected. Twenty-one of the 29 patients survived to discharge (72%). None of the deaths was transport related.
  
  
  CONCLUSIONS
  Tertiary intensive care units and ECMO centers require a dedicated transport team. ECMO transports can be performed safely for all age groups for long distances, probably throughout most of Europe.
authors.affiliation: Department of Pediatric Anesthesiology and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Lindén
authors.forename: K
authors.initials: K
authors.lastname: Palmér
authors.forename: J
authors.initials: J
authors.lastname: Reinhard
authors.forename: R
authors.initials: R
authors.lastname: Westman
authors.forename: H
authors.initials: H
authors.lastname: Ehrén
authors.forename: T
authors.initials: T
authors.lastname: Granholm
authors.forename: B
authors.initials: B
authors.lastname: Frenckner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017732:Air Ambulances; D000552:Ambulances; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010360:Patient Transfer / Q000379:methods* / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome