title: Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center.
abstract: Patients with severe cardiac or pulmonary failure who require transport to specialized hospitals currently pose a challenge. Mechanical support in the form of extracorporeal membrane oxygenation (ECMO) may increase the safety of transporting such patients to an institution where they will have access to advanced medical therapy. Over 2.5 years, 17 patients were successfully cannulated and placed on a simplified ECMO circuit at other institutions and transported via ambulance to our hospital. Fourteen patients with acute respiratory distress syndrome (ARDS) were placed on venovenous (VV) ECMO. Two patients with isolated cardiogenic shock and one patient with ARDS were placed on venoarterial (VA) ECMO. The two cardiogenic shock patients were converted to a biventricular assist device shortly after arrival. The median unit-to-unit transport time was 60 minutes (interquartile range 50-92 minutes), and the median distance traveled was 23 miles (interquartile range 17-55 miles). There was no transport-related morbidity or mortality. The median duration of ECMO support was 8 days (interquartile range 4-11 days). Thirteen patients (76%) were successfully decannulated. Ten patients (59%) were weaned from the ventilator, and nine patients (53%) survived up to 3 months and were discharged from the hospital. Critically ill patients with severe ARDS or cardiogenic shock can be safely transported on VV or VA ECMO support to regional ECMO centers. As the indications and demands for ECMO support expand, so will the role for transporting patients on ECMO.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York City, New York, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Javidfar
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Linda
authors.initials: L
authors.lastname: Mongero
authors.forename: Joseph
authors.initials: J
authors.lastname: Zwischenberger
authors.forename: Joshua
authors.initials: J
authors.lastname: Sonett
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D000552:Ambulances; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D016730:Program Development; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012770:Shock, Cardiogenic / Q000628:therapy; D014187:Transportation of Patients; D016896:Treatment Outcome