Helicopter inter-hospital transfer for patients undergoing extracorporeal membrane oxygenation: a retrospective 12-year analysis of a service system

Abstract

Background Patients undergoing extracorporeal membrane oxygenation (ECMO) are critically ill and show high mortality. Inter-hospital transfer of these patients has to be safe, with high survival rates during transport without potentially serious and life-threatening adverse events. The Swiss Air-Rescue provides 24-h/7-days per week inter-hospital helicopter transfers that include on-site ECMO cannulation if needed. This retrospective observational study describes adverse events of patients on ECMO transported by helicopter, and their associated survival. Methods All patients on ECMO with inter-hospital transfer by helicopter from start of service in February 2009 until May 2021 were included. Patients not transported by helicopter or with missing medical records were excluded. Patient demographics (age, sex) and medical history (type of and reason for ECMO), mission details (flight distance, times, primary or secondary transport), adverse events during the inter-hospital transfer, and survival of transferred patients were recorded. The primary endpoint was patient survival during transfer. Secondary endpoints were adverse events during transfer and 28-day survival. Results We screened 214 ECMO-related missions and included 191 in this analysis. Median age was 54.6 [IQR 46.1–62.0] years, 70.7% were male, and most patients had veno-arterial ECMO (56.5%). The main reasons for ECMO were pulmonary (46.1%) or cardiac (44.0%) failure. Most were daytime (69.8%) and primary missions (n = 100), median total mission time was 182.0 [143.0–254.0] min, and median transfer distance was 52.7 [33.2–71.1] km. All patients survived the transfer. Forty-four adverse events were recorded during 37 missions (19.4%), where 31 (70.5%) were medical and none resulted in patient harm. Adverse events occurred more frequently during night-time missions (59.9%, p = 0.047). Data for 28-day survival were available for 157 patients, of which 86 (54.8%) were alive. Conclusion All patients under ECMO survived the helicopter transport. Adverse events were observed for about 20% of the flight missions, with a tendency during the night-time flights, none harmed the patients. Inter-hospital transfer for patients undergoing ECMO provided by 24-h/7-d per week helicopter emergency medical service teams can be considered as feasible and safe. The majority of the patients (54.8%) were still alive after 28 days.

VV‐ECMO as bridge and safety net for successful therapeutic polypragmasy in a case of influenza‐triggered near‐fatal asthma

“…The on-site ECMO implantation and transport under ECMO are generally considered safe to perform, an experience that has also been consolidated during the COVID pandemic. 11,12 Although the use of ECMO in the described case can be considered free of major complications, minor bleeding from the cannulation sites required repetitive transfusion of blood products (in total 14 red blood cells and 2 platelet concentrates). Due to the necessity of anticoagulation, bleeding is among the most common complications in ECMO therapy.…”

“…Transport to an ECMO center requires on‐site ECMO cannulation and initiation in some clinical situations to allow for transport. The on‐site ECMO implantation and transport under ECMO are generally considered safe to perform, an experience that has also been consolidated during the COVID pandemic 11,12 …”

AHN LifeFlight, 45 Years in the Making

“…During ECMO transports, the 2 flight crew members will be accompanied by a perfusionist, who will manage the ECMO pump. 6 All other patient care, medication, and medical equipment are the responsibility of the LifeFlight crew members.…”

“…AHN LifeFlight also possesses the ability to complete extracorporeal membrane oxygenation (ECMO) transports by air. During ECMO transports, the 2 flight crew members will be accompanied by a perfusionist, who will manage the ECMO pump 6. All other patient care, medication, and medical equipment are the responsibility of the LifeFlight crew members.…”

Factors influencing on-scene time in a physician-staffed helicopter emergency medical service (HEMS): a retrospective observational study

“…In Switzerland, the emergency medical system consists of paramedic-staffed ground ambulances and the emergency, physician-staffed Helicopter Emergency Medical Services (HEMS). HEMS patient transport is considered safe, ensures short intervention times and offers access to difficult and remote regions [ 4 – 6 ]. On-scene HEMS physicians diagnose patient illnesses or conditions earlier and perform or initiate advanced life-saving critical interventions, which improve the survival rates of trauma patients [ 6 , 7 ].…”