Mobile Extracorporeal Membrane Oxygenation for Covid-19 Does Not Pose Extra Risk to Transport Team

Abstract

for the Covid-19 CritiCaL Care ConSortium Previous experience has shown that transporting patients on extracorporeal membrane oxygenation (ECMO) is a safe and effective mode of transferring critically ill patients requiring maximum mechanical ventilator support to a quaternary care center. The coronavirus disease 2019 (COVID-19) pandemic posed new challenges. This is a multicenter, retrospective study of 113 patients with confirmed severe acute respiratory syndrome coronavirus 2, cannulated at an outside hospital and transported on ECMO to an ECMO center. This was performed by a multidisciplinary mobile ECMO team consisting of physicians for cannulation, critical care nurses, and an ECMO specialist or perfusionist, along with a driver or pilot. Teams practised strict airborne contact precautions with eyewear while caring for the patient and were in standard Personal Protective Equipment. The primary mode of transportation was ground. Ten patients were transported by air. The average distance traveled was 40 miles (SD ±56). The average duration of transport was 133 minutes (SD ±92).When stratified by mode of transport, the average distance traveled for ground transports was 36 miles (SD ±52) and duration was 136 minutes (SD ±93). For air, the average distance traveled was 66 miles (SD ±82) and duration was 104 minutes (SD ±70). There were no instances of transportrelated adverse events including pump failures, cannulation complications at outside hospital, or accidental decannulations or dislodgements in transit. There were no instances of the transport team members contracting COVID-19 infection within 21 days after transport. By adhering to best practices and ACE precautions, patients with COVID-19 can be safely cannulated at an outside hospital and transported to a quaternary care center without increased risk to the transport team.

Risk of COVID‐19 infection among mobile extracorporeal membrane oxygenation team

“…That report did not specify what, if any, testing measures were put in place for the ECMO team members, so some may have been contaminated and remained asymptomatic. The aforementioned reports 28,29 are in accordance with a multicentric study that suggested mobile ECMO does not add additional hazard to the ECMO transport team 30 …”

“…The aforementioned reports 28,29 are in accordance with a multicentric study that suggested mobile ECMO does not add additional hazard to the ECMO transport team. 30 Another study demonstrated a very low risk of COVID-19 contamination to EMS and reported an incidence of 0.57 infections/ 10,000 person-days over a similar study period. 31 Our study, however, is based on a higher number of COVID-…”

“…The aforementioned reports 28 , 29 are in accordance with a multicentric study that suggested mobile ECMO does not add additional hazard to the ECMO transport team. 30 …”

Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study

“…Adequate training, appropriate infection prevention control measures, personal protective equipment (PPE), and ambulance disinfection are essential for patient and medical personnel safety. Other transport safety suggestions may include adequate ventilation of the transport platform, the use of dedicated routes for patients with COVID-19 during intrahospital patient transport, and an additional filter on the expiratory limb of the transport ventilator [ 41 , 42 ].…”

Interhospitaler Intensivtransport

“…Obwohl solche Transporte durch die PSA eine deutlich höhere Belastung für das Transportteam darstellen, sind sie unter Beachtung entsprechender Schutzmaßnahmen sicher durchführbar (Abb. 3 ; [ 15 ]).

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