title: Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction.
abstract: OBJECTIVE
  Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO. Our center has a 20-year experience in carrying out such transports. The purpose of this study was twofold: (1) to review our experience with pediatric cardiac patients undergoing CM-ECMO and (2) identify risk factors for a composite outcome (defined as either cardiac transplantation or death) among children undergoing CM-ECMO.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Cardiovascular intensive care and pediatric transport system.
  
  
  METHODS
  Children (n = 37) from 0-18 years undergoing CM-ECMO transports (n = 38) between January 1990 and September 2005.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 38 CM-ECMO transports were performed for congenital heart disease (n = 22), cardiomyopathy (n = 11), and sepsis with myocardial dysfunction (n = 4). There were 18 survivors to hospital discharge. Twenty-two patients were transported a distance of more than 300 miles from our institution. Ten patients were previously cannulated and on ECMO prior to transport. Thirty-five patients were transported by air and two by ground. Six patients underwent cardiac transplantation, all of whom survived to discharge. After adjusting for other covariates post-CM-ECMO renal support was the only variable associated with the composite outcome of death/need for cardiac transplant (odds ratio = 13.2; 95% confidence interval, 1.60--108.90; P = 0.003). There were two minor complications (equipment failure/dysfunction) and no major complications or deaths during transport.
  
  
  CONCLUSIONS
  Air and ground CM-ECMO transport of pediatric patients with refractory myocardial dysfunction is safe and effective. In our study cohort, the need for post-CM-ECMO renal support was associated with the composite outcome of death/need for cardiac transplant.
authors: Department of Pediatrics, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors: Antonio G
authors: AG
authors: Cabrera
authors: Parthak
authors: P
authors: Prodhan
authors: Mario A
authors: MA
authors: Cleves
authors: Richard T
authors: RT
authors: Fiser
authors: Michael
authors: M
authors: Schmitz
authors: Eudice
authors: E
authors: Fontenot
authors: Wesley
authors: W
authors: McKamie
authors: Carl
authors: C
authors: Chipman
authors: Robert D B
authors: RD
authors: Jaquiss
authors: Michiaki
authors: M
authors: Imamura
mesh_terms: D000293:Adolescent; D017732:Air Ambulances; D000552:Ambulances; D001131:Arkansas; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006439:Hemodynamics; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D010360:Patient Transfer; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome