Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

Abstract

In recent years the number of extracorporeal membrane oxygenation (ECMO) cases in neonates has been relatively constant. Future expansion lays in new indications for treatment. Regionalization to high-volume ECMO centers allows for optimal utilization of resources, reduction in costs, morbidity, and mortality. Mobile ECMO services available “24-7” are needed to provide effective logistics and reliable infrastructure for patient safety. ECMO transports are usually high-risk and complex. To reduce complications during ECMO transport communication using time-out, checklists, and ECMO A-B-C are paramount in any size mobile program. Team members' education, clinical training, and experience are important. For continuing education, regular wet-lab training, and simulation practices in teams increase performance and confidence. In the future the artificial placenta for the extremely premature infant (23–28 gestational weeks) will be introduced. This will enforce the development and adaptation of ECMO devices and materials for increased biocompatibility to manage the high-risk prem-ECMO (28–34 weeks) patients. These methods will likely first be introduced at a few high-volume neonatal ECMO centers. The ECMO team brings bedside competence for assessment, cannulation, and commencement of therapy, followed by a safe transport to an experienced ECMO center. How transport algorithms for the artificial placentae will affect mobile ECMO is unclear. ECMO transport services in the newborn should firstly be an out-reach service led and provided by ELSO member centers that continuously report transport data to an expansion of the ELSO Registry to include transport quality follow-up and research. For future development and improvement follow-up and sharing of data are important.

Complications of ECMO During Transport

“…Use of the ECMO A-B-C checklist, which is a specialized device-patient interface checklist, is recommended. 10 There were two safety issues in this case. First, after the elevator event, the transport team may have been falsely reassured because the patient remained stable.…”

“…The team should perform the time out and complete the checklist before leaving any location. Use of the ECMO A‐B‐C checklist, which is a specialized device‐patient interface checklist, is recommended 10 …”

Premature and Extracorporeal Life Support: Is it Time? A Systematic Review

“…Extracorporeal membrane oxygenation transport services for these prematurely born should be an out-reach service led and provided by ELSO member centers that continuously report transport data to the ELSO Registry for transparency and follow-up. 111…”

Extracorporeal membrane oxygenation in the forensic setting: A series of 19 forensic cases

“…While other large academic medical centers are likely to have a similar or even higher case rate (owing to an overall greater population density and case volume), it is likely that small medical examiner offices would possibly see only 1 such case per year or less. However, as the clinical use of ECMO continues to increase, it is likely that more forensic cases will trickle into the community, especially as ECMO becomes a more common option for patient transfer and referral [33, 34]. As we have shown, ECMO cases are inherently complicated.…”

“…Our case distribution may also be further skewed given our institution's position as a major academic medical center which serves as a regional referral center for ECMO. While other large academic medical centers are likely to have a similar or even higher case rate (owing to an overall greater population density and case volume), it is likely that small medical examiner offices would possibly see only continues to increase, it is likely that more forensic cases will trickle into the community, especially as ECMO becomes a more common option for patient transfer and referral [33,34]. As we have shown, ECMO cases are inherently complicated.…”