Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature.
BACKGROUND
Utilization of extracorporeal membrane oxygenation (ECMO) has increased worldwide, but its use remains restricted to severely ill patients, and few referral centers are properly structured to offer this support. Inter-hospital transfer of patients on ECMO support can be life-threatening. In this study, we report a single-center experience and a systematic review of the available published data on complications and mortality associated with ECMO transportation.


METHODS
We reported single-center data regarding complications and mortality associated with the transportation of patients on ECMO support. Additionally, we searched multiple databases for case series, observational studies, and randomized controlled trials regarding mortality of patients transferred on ECMO support. Results were analyzed independently for pediatric (under 12 years old) and adult populations. We pooled mortality rates using a random-effects model. Complications and transportation data were also described.


RESULTS
A total of 38 manuscripts, including our series, were included in the final analysis, totaling 1481 patients transported on ECMO support. A total of 951 patients survived to hospital discharge. The pooled survival rates for adult and pediatric patients were 62% (95% CI 57-68) and 68% (95% CI 60-75), respectively. Two deaths occurred during patient transportation. No other complication resulting in adverse outcome was reported.


CONCLUSIONS
Using the available pooled data, we found that patient transfer to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients.
Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil. pemendes@hotmail.com.|Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil. pemendes@hotmail.com.
Pedro Vitale
PV
Mendes
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Cesar
C
de Albuquerque Gallo
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Bruno Adler Maccagnan Pinheiro
BAMP
Besen
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Adriana Sayuri
AS
Hirota
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Raquel
R
de Oliveira Nardi
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Edzangela Vasconcelos
EV
Dos Santos
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Ho Yeh
HY
Li
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Daniel
D
Joelsons
Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.|Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Eduardo Leite Vieira
ELV
Costa
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Flavia Krepel
FK
Foronda
Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.|Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Luciano Cesar Pontes
LCP
Azevedo
Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
Marcelo
M
Park
Acute respiratory failure; Extracorporeal membrane oxygenation; Rescue work; Transport