Long-distance transport of critically ill children on extracorporeal life support in Australia.
BACKGROUND
The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon.


METHODS
Retrospective review of eight children (aged between 1 day and 8 years) who were transported on ECLS to the intensive care unit at the Royal Children's Hospital, Melbourne, between 2003 and 2007.


RESULTS
Seven patients underwent cannulation by our team in the referring ICU, and one underwent cannulation by the referring centre before our retrieval team arrived. Seven children were placed on ECMO (veno-venous in two, veno-arterial in five), and one was placed on a left ventricular assist device. Five children were retrieved from interstate ICUs by air, and three were transported from a metropolitan ICU by road. The median distance from the referral centre to Melbourne was 803 km, and the median duration of retrieval was 13 hours. Median duration of ECLS was 270 hours. Five patients survived to hospital discharge. There were no adverse outcomes related to transport.


CONCLUSIONS
This is the first report of ECLS transport in Australia. In our experience, children who would not otherwise be transportable can be safely transported long distances on ECLS, and should be offered this if appropriate resources exist. However, this approach should not replace the timely referral of patients who are likely to need ECLS.
Perez
Armando
A
Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia.
Butt
Warwick W
WW
Millar
Kenneth J
KJ
Best
Derek
D
Thiruchelvam
Timothy
T
Cochrane
Andrew D
AD
Bennett
Martin
M
Shekerdemian
Lara S
LS
D002648:Child; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D006801:Humans; D015278:Intensive Care Units, Pediatric; D012189:Retrospective Studies; D014739:Victoria