title: Logistics and safety of extracorporeal membrane oxygenation in medical retrieval.
abstract: OBJECTIVE
  This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia.
  
  
  METHODS
  We describe the logistics involved in ECMO road and rotary-wing retrieval by a multidisciplinary team during the H1N1 influenza epidemic in winter 2009 (i.e., June 1 to August 31, 2009). Basic patient demographics and key retrieval time lines were analyzed.
  
  
  RESULTS
  There were 17 patients retrieved on ECMO, with their ages ranging from 22 to 55 years. The median weight was 110 kg. Four critical events were recorded during retrieval, with no adverse outcomes. The retrieval distance varied from 20.8 to 430 km. There were delays in times from retrieval booking to both retrieval tasking and retrieval team departure in 88% of retrievals. The most common reasons cited were "patient not ready" 23.5% (4/17); "vehicle not available," 23.5% (4/17); and "complex retrieval," 41.2% (7/17). The median time (hours:minutes) from booking with the medical retrieval unit (MRU) to tasking was 4:35 (interquartile range [IQR] 3:27-6:15). The median time lag from tasking to departure was 1:00 (IQR 00:10-2:20). The median stabilization time was 1:30 (IQR 1:20-1:55). The median retrieval duration was 7:35 (IQR 5:50-10:15).
  
  
  CONCLUSIONS
  The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service, Bankstown, Australia. bburns 2000@yahoo.com
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Burns
authors.forename: Karel
authors.initials: K
authors.lastname: Habig
authors.forename: Cliff
authors.initials: C
authors.lastname: Reid
authors.forename: Paul
authors.initials: P
authors.lastname: Kernick
authors.forename: Chris
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Gary
authors.initials: G
authors.lastname: Tall
authors.forename: Sarah
authors.initials: S
authors.lastname: Coombes
authors.forename: Ron
authors.initials: R
authors.lastname: Manning
mesh_terms: D000328:Adult; D017732:Air Ambulances; D001315:Australia; D003422:Critical Care / Q000379:methods*; D004196:Disease Outbreaks; D004632:Emergency Medical Services / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D016526:Workload; D055815:Young Adult