Intrahospital transport of children on extracorporeal membrane oxygenation: Indications, process, interventions, and effectiveness

Abstract

Objective-Critically ill patients supported with extracorporeal membrane oxygenation (ECMO) are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one ICU to another. No studies to date have systematically evaluated intrahospital transport (IHT) while on ECMO. This study aims to evaluate indications, process, interventions, and effectiveness of patients undergoing IHT. Design-Retrospective cohort analysis.Setting-Cardiac intensive care unit in a tertiary care children's hospital.Patients-All patients requiring IHT while on ECMO between January 1996 and March 2007 were included and analyzed in detail. Measurement and MainResults-A total of 57 IHTs for cardiac catheterization (CC) and head CT scans were analyzed. In 14/20 (70%) of CC patients, a management change occurred as a result of the diagnostic CC. In 10/17 (59%) bedside echo was of limited value in defining the critical problem. In the interventional group the majority of transports were for atrial septostomy. In the head CT group significant pathology was identified, which led to management change. No major complications occurred during these IHTs. NIH Public AccessConclusions-IHT while on ECMO is labor intensive and requiring extensive logistic support, it can be carried out safely in experienced hands and results in important therapeutic and diagnostic yields. To our knowledge this is the first study designed to evaluate safety and efficacy of IHT for patients receiving ECMO support.

Safety of Intrahospital Transport in Ventilated Critically Ill Patients

“…Single-center and multicenter observational studies have shown that IHT carries risks in adult and pédiatrie ICU patients and in emergency department patients (5,(24)(25)(26)(27)(28)(29). Previous reported complications associated with IHT range from changes in vital signs to unexpected serious complications requiring major therapeutic interventions (1, 3, 28, 30, 31).…”

“…ICU patients frequently require transportation to other sites within the hospital for procedures that are not available at the bedside (7,23,24). Single-center and multicenter observational studies have shown that IHT carries risks in adult and pédiatrie ICU patients and in emergency department patients (5,(24)(25)(26)(27)(28)(29).…”

Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival

“…Cardiac catheterization is much more successful in identifying important residual cardiac defects in postoperative patients on ECMO, compared to non‐invasive imaging such as echocardiography. In fact, cardiac catheterization detects residual lesions about four times more frequently than echo in cardiac ECMO patients .…”

“…Transport of critically ill patients supported on ECMO creates enormous logistical challenges and requires coordination of multiple services. Most of the transports on ECMO support are to the catheterization laboratory or to the radiologic suite and can be done safely in centers with experience . Recent data from IMPACT registry reveals that 86% of all pediatric cardiac catheterizations are performed under general anesthesia .…”

Interhospital transfer of children in respiratory failure: a clinician interview qualitative study

“…Similar concern was raised regarding institution of HFOV therapy as it might preclude transfer given that it is not routinely delivered during transport. These observations highlight potential barriers to timely and safe patient transfer and raise the need to consider all viable transport options including the cannulation of patients onto ECMO at the referring hospital prior to transfer [14, 15] or institution of innovative transport processes, as illustrated in a recent report of patient transport on HFOV, a procedure previously deemed impossible [16]. The risks associated with transport deserve due consideration in any transfer decision-making process in order to not jeopardize patient safety either via disruption of ongoing intensive care or from progression of disease during transport without the ability to maximally support the patient.…”