A 22-year experience in global transport extracorporeal membrane oxygenation.
OBJECTIVE
Transport extracorporeal membrane oxygenation (ECMO) is currently available at 12 centers. We report a 22-year experience from the only facility providing global transport ECMO. Indications for transport ECMO include lack of ECMO services, inability to transport conventionally, inability to wean from cardiopulmonary bypass, extracorporeal cardiopulmonary resuscitation, and need to move a patient on ECMO for specialized services such as organ transplantation.


METHODS
Retrospective database review of children undergoing inhouse and transport ECMO from 1985 to 2007.


RESULTS
Sixty-eight children underwent transport ECMO. Fifty-six were transported on ECMO into our facility. The remaining 12 were moved between 2 outside locations. Ground vehicles and fixed-wing aircraft were used. Distance transported was 8 to 7500 miles (13-12070 km), mean 1380 miles (2220 km). There were 116 inhouse ECMO runs. No child died during transport. Survival to discharge after transport ECMO was 65% (44/68) and, for inhouse ECMO, was 70% (81/116).


CONCLUSIONS
Transport ECMO is feasible and effective, with survival rates comparable to inhouse ECMO. We have used transport ECMO to help children at non-ECMO centers with pulmonary failure who have not improved with inhaled nitric oxide and high-frequency ventilation. We have also transported a child after extracorporeal cardiopulmonary resuscitation, which may represent an emerging indication for transport ECMO. Transport ECMO often is the only option for children too unstable for conventional transport or those already on ECMO and requiring a specialized service at another facility, such as organ transplantation.
Coppola
Christopher P
CP
Department of Surgery, Wilford Hall Medical Center, San Antonio, Lackland AFB, TX 78236, USA. ccoppola@pol.net
Tyree
Melissa
M
Larry
Karen
K
DiGeronimo
Robert
R
D017732:Air Ambulances / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data; D002675:Child, Preschool; D004869:Equipment Safety; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010360:Patient Transfer / Q000379:methods*; D012042:Registries; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods; D016896:Treatment Outcome; D014481:United States