Inter-hospital COVID ECMO air transportation

Armas, Ismael A. Salas de; Akkanti, Bindu; Janowiak, Lisa; Banjac, Igor; Dinh, Kha; Hussain, Rahat; Cabrera, Rodolfo; Herrera, Tony; Sanger, Damon; Akay, Mehmet H.; Patel, Jayeshkumar; Patel, Manish Kumar; Kumar, Sachin; Jumean, Marwan; Kar, Biswajit; Gregorič, Igor D.

doi:10.1177/0267659120973843

Cited by 15 publications

(15 citation statements)

References 9 publications

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“…Another benefit of the Level I trauma center capabilities is the FAA-approved transport of ECMO patients via helicopter which contributes to faster patient access. 28 The complexity of ECMO support requires a multidisciplinary team of clinicians, as well as financial and physical resources for its optimal implementation. Our data provide preliminary evidence of the feasibility and safety of VV ECMO use in a trauma patient cohort by providing an 87% survival-to discharge outcome.…”

Section: Discussionmentioning

confidence: 99%

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

et al. 2021

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Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

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Section: Discussionmentioning

confidence: 99%

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

et al. 2021

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“…In conclusion, in this era of multiple infectious disease outbreaks, ECMO preparedness is of utmost importance [ 17 , 46 , 47 ]. The transportation of patients under ECMO support in helicopter is feasible, but it is important to document hospital-specific protocols and procedures to inscribe the ECMO transportation in a wide framework of critically-ill patients.…”

Section: Discussionmentioning

confidence: 99%

ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms

et al. 2021

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The retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a vast area in southern Italy and Malta. This observational, descriptive study includes all patients that required veno–venous (V-V) ECMO and transport by a mobile team between October 2009 and May 2020. Linear and multiple logistic regressions were applied to explore the risk factors for mortality in the ICU. Kaplan–Meier estimates were generated to predict the survival in patients transported by helicopter or ambulance, and the two cohorts were compared according to their baseline characteristics. Of 122 patients transported, 89 (73%) survived to ICU discharge (50 (41%) patients were transported by ambulance, and 72 (59%) were transported by helicopter). Independent predictive factors associated with mortality in a stepwise multiple regression model were prone positioning, acute kidney injury, and the number of days spent on mechanical ventilation (MV). Kaplan–Meier estimates for survival favored the helicopter cohort (79%) rather than the ambulance cohort (64%). Patients transported by helicopter had better pre-ECMO profiles, with shorter hospital and ICU stays, a shorter duration of MV use, and higher RESP scores, which indicate better survival probabilities. ECMO transport can be carried out safely over long distances; in rural areas with underdeveloped roads, transportation via helicopter or ambulance can extend the arm of the hospital to remote areas. Early ECMO initiation can be crucial in improving survival outcomes, and when transportation is the limiting factor to starting ECMO support, it should be attempted at the earliest logistical stage possible.

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“…However, successful air transports of ECMO patients with COVID-19 have been described by other teams by streamlining of their processes during this COVID-19 pandemic. 15 Whereas COVID-19 numbers may plateau soon as the vaccination efforts go up, it is unclear, with new variants, whether we will ever be able to go back to the prepandemic world in the near future. Precautions and protection of transport staff with PPE may well become the new standard of care for mobile ECMO teams.…”

Section: Discussionmentioning

confidence: 99%

Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience

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Blakeman

DeValeria

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Inter-facility transport of a critically ill patient with Acute Respiratory Distress Syndrome (ARDS) may be necessary for a higher level of care and/or initiation of extracorporeal membrane oxygenation (ECMO). During the COVID19 pandemic, ECMO has been used for patients with severe ARDS with successful results. Transporting a patient after ECMO cannulation by the receiving facility brings forth logistic challenges including availability of adequate Personal Protective Equipment (PPE) for the transport team and hospital capacity management issues. We report our designated ECMO transport team’s experience with five patients with COVID19 associated severe ARDS after cannulation at the referring facility. Focusing on transport associated logistics, creation of checklists, and collaboration with EMS partners is necessary for safe and good outcomes for patients while maintaining team safety.

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Inter-hospital COVID ECMO air transportation

Cited by 15 publications

References 9 publications

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms

Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience

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