title: The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation.
abstract: BACKGROUND
  In severe respiratory and/or circulatory failure, extracorporeal membrane oxygenation (ECMO) may be a lifesaving procedure. Specialized departments provide ECMO, and these patients often have to be transferred for treatment. Conventional transportation is hazardous, and deaths have been described. Only a few centers have performed more than 100 ECMO transports. To date, our mobile ECMO teams have performed more than 700 transports with patients on ECMO since 1996. We describe 4 consecutive years (2010-2013) of 322 national and international ECMO transports and report adverse events.
  
  
  METHODS
  Data were retrieved from our local databases. Neonatal, pediatric and adult patients were transported, predominantly with refractory severe respiratory failure.
  
  
  RESULTS
  The patients were cannulated in 282 of the transports, and ECMO was started in these patients at the referring hospital and then they were transported to our ECMO intensive care unit. In 40 cases, the patient was already on ECMO. Of the transports, 60% were by aircraft, and the distances varied from 6.9 to 13,447 km. In about 27.3% of the transports, adverse events occurred. Of these, the most common were either patient-related (22%) or equipment-related (5.3%). No deaths occurred during transport, and transferred patients exhibited the same mortality rate as in-hospital patients.
  
  
  CONCLUSIONS
  Long- and short-distance interhospital transports on ECMO can be safely performed. A myriad of complications can occur, but the mortality risk is very low. The staff involved should be highly competent in intensive care, ECMO physiology and physics, cannulation, intensive care transport and air transport medicine. They should also be skilled in recognition of risk factors involved in these patients.
authors.affiliation: ECMO Center Karolinska, Karolinska University Hospital, 171 76, Stockholm, Sweden. lars.broman@karolinska.se.
authors.forename: L Mikael
authors.initials: LM
authors.lastname: Broman
authors.affiliation: ECMO Center Karolinska, Karolinska University Hospital, 171 76, Stockholm, Sweden. bernhard.holzgraefe@karolinska.se.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzgraefe
authors.affiliation: ECMO Center Karolinska, Karolinska University Hospital, 171 76, Stockholm, Sweden. kenneth.palmer@karolinska.se.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Palmér
authors.affiliation: Department of Pediatric Surgery, Women's and Children's Health, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden. bjorn.frenckner@karolinska.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Frenckner
mesh_terms: D000552:Ambulances; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D010348:Patient Care Team; D061214:Patient Safety; D010360:Patient Transfer; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013548:Sweden; D062606:Tertiary Care Centers