Background Severe acute respiratory distress syndrome (ARDS) is associated with high mortality. The International Extracorporeal Membrane Oxygenation network recommends regionalization of extracorporeal life support (ECLS) to high volume centers and development of mobile ECLS teams to rescue patients with severe acute respiratory disease. Methods A tertiary medical center developed a mobile team and the infrastructure to support a 24/7 ECLS transport service. We conducted a retrospective study of all consecutive patients presenting for ECLS for severe ARDS from outside hospitals through our mobile ECLS program associated with hemodynamic instability from Jan 1, 2015 until December 31st, 2015. Results During the study period, 106 consults for ECLS were received and 36 patients were placed on ECLS. Of these 36 ECLS patients, 11 were deemed stable enough for transport prior to ECLS, and 21 required mobile ECLS by the mobile ECLS, with a survival of 67% (14/21). The other 4 ECLS patients were in-house patients and thus received ECLS in a non-mobile fashion. In addition, 28 patients were transferred to our hospital who did not receive ECLS. Patient survival increased significantly with increased experience of the program, as the highest mortality rates were early in the program (p=0.006) and in conjunction with stricter adherence to our exclusion criteria. Conclusions The formation of a mobile ECLS program is a complex undertaking which took two years of planning to develop. Development of criteria for ECLS implementation can guide appropriate resource utilization and may prevent use in patients with little to no chance of survival.

SummaryWe report a case of severe sand aspiration in association with near‐drowning, which led to respiratory failure secondary to the acute respiratory distress syndrome, necessitating mechanical ventilation, repeated therapeutic bronchoscopic lavage, and a stay in the intensive care unit that exceeded one month.

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