Extracorporeal Membrane Oxygenation and Interfacility Transfer: A Regional Referral Experience

Abstract

Outcomes are favorable after transport to high-volume ECMO centers. Guidelines and infrastructure for short- and long-distance ECMO transport is imperative for the efficient and successful management of these patients.

Outcomes of out-of-hospital extracorporeal membrane oxygenation transfers: significance of initiation site and personnel

“…Studies from other recent ECMO centers also did not report any transfer-related complications. 1,11 In contrast to these publications from 2017, a study conducted from 1990 to 1999 by Foley et al 12 observed 10 cases of electric failure, 3 cases of circuit tubing leakage, and 1 case each of circuit rupture, membrane lung thrombosis, and membrane lung leakage. These improvements in transfer complications likely reflect the advancement of technology, experience, and knowledge of ECMO transfer.…”

“…Therefore, sufficient experience and expertise at ECMO centers, supplemented by an established inter-institutional network as a hub (ECMO center) and spokes (non-ECMO centers and transport system) system, can effectively improve patient outcomes. 1,4,6 Despite these studies suggesting a favorable outcome in large ECMO centers, the outcomes of cases initiated at non-ECMO centers that were subsequently transported to an ECMO center for management require further research. The purpose of this study is to investigate the safety and outcome of ECMO transfer from non-ECMO centers to a single institution ECMO center.…”

“…Previous reports showed that outcomes in high-volume ECMO centers are favorable. 1,2 In contrast, low-volume centers have inferior survival outcomes. 2 Medical centers with more than 30 annual adult ECMO cases had significantly lower odds of mortality than those with less than 6 annual cases.…”

“…Therefore, sufficient experience and expertise at ECMO centers, supplemented by an established inter-institutional network as a hub (ECMO center) and spokes (non-ECMO centers and transport system) system, can effectively improve patient outcomes. 1,4,6…”

Give Me Your Tired, Your Poor, Your Extracorporeal Membrane Oxygenation Patients

“…Several studies have shown that VA ECMO patients in cardiogenic shock can be cannulated safely by outside hospital physicians and safely transferred, as long as the transfer team has experience with ECMO. 7,8 International transfer of ECMO patients has even been shown to be safe. 9 An alternative approach might be to develop mobile VA ECMO teams based out of the ECMO referral center.…”