Mobile Extracorporeal Membrane Oxygenation Teams: The North American Versus the European Experience

Nwozuzu, Adambeke; Fontes, Manuel L.; Schonberger, Robert B.

doi:10.1053/j.jvca.2016.06.005

Cited by 25 publications

(12 citation statements)

References 34 publications

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“…In each of these descriptions, patient selection, stringent adherence to safety protocols, and significant investment in personnel education and training represent the sine qua non of inter-facility ECMO transport. Although the specific makeup of the ECMO transport team appears to have some geographical variation, with European centers incorporating more anesthesiologists relative to North American centers, 87 the consistent elements in all ECMO transport centers lie in exhaustive preparation and both individual and team education and training.…”

Section: Ecmo Transportmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

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Extracorporeal membrane oxygenation (ECMO) was developed initially in the 1960s to support refractory respiratory failure in addition to the cardiac support inherent in a venoarterial bypass circuit. Early successes occurred predominantly in the neonatal population with subsequent randomized controlled trials and comprehensive reviews concluding therapeutic efficacy for ECMO in neonatal respiratory failure. In contrast, the evidence supporting ECMO for respiratory failure in children is less definitive. However, although pediatric randomized controlled trials have not been completed, sufficient evidence in support of ECMO as a beneficial therapy for pediatric respiratory failure exists. The acceptance of clinical utility and benefit from ECMO for pediatric ARDS and the trend toward increasing venovenous ECMO use have led to its inclusion in the Pediatric Acute Lung Injury Consensus Conference as a strongly agreed upon recommendation for severe pediatric ARDS. However, the Pediatric Acute Lung Injury Consensus Conference recommendations supporting the use of ECMO for pediatric ARDS highlight the lack of evidence-based selection criteria when determining ECMO candidacy in pediatric patients with ARDS. Ultimately, decisions to proceed with ECMO and the concomitant risk of potential life-threatening complications must consider multiple factors that balance potential risks and likelihood of benefit, pre-morbid conditions and impact on potential post-ECMO quality of life, candidacy for lung transplantation, and patient and family goals of care. This review will discuss ECMO for the support of pediatric respiratory failure, ventilator management during ECMO, considerations impacting timing of decannulation, and developing techniques.

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Section: Ecmo Transportmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

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“…14,15 A recent review of transports on ECMO in North America and Europe by Nwozuzu and colleagues established that North American transports are much less likely to have an anesthesiologist on board compared to European transports and suggested that there should be more accompanied transports. 22 These recommendations appeared based on qualitative observations of adverse events in ECMO transports and an experienced respect for the challenge of responding to complications that may occur in patients on ECMO.…”

Section: Discussionmentioning

confidence: 99%

ECMO Transport without Physicians or Additional Clinicians

Condella

Richards

Frakes³

et al. 2020

Prehosp. Disaster med.

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Background: Extracorporeal membrane oxygenation (ECMO) has accelerated rapidly for patients in severe cardiac or respiratory failure. As a result, ECMO networks are being developed across the world using a “hub and spoke” model. Current guidelines call for all patients transported on ECMO to be accompanied by a physician during transport. However, as ECMO centers and networks grow, the increasing number of transports will be limited by this mandate. Objectives: The aim of this study was to compare rates of adverse events occurring during transport of ECMO patients with and without an additional clinician, defined as a physician, nurse practitioner (NP), or physician assistant (PA). Methods: This is a retrospective cohort study of all adults transported while cannulated on ECMO from 2011-2018 via ground and air between 21 hospitals in the northeastern United States, comparing transports with and without additional clinicians. The primary outcome was the rate of major adverse events, and the secondary outcome was minor adverse events. Results: Over the seven-year study period, 93 patients on ECMO were transported. Twenty-three transports (24.7%) were accompanied by a physician or other additional clinician. Major adverse events occurred in 21.5% of all transports. There was no difference in the total rate of major adverse events between accompanied and unaccompanied transports (P = .91). Multivariate analysis did not demonstrate any parameter as being predictive of major adverse events. Conclusions: In a retrospective cohort study of transports of ECMO patients, there was no association between the overall rate of major adverse events in transport and the accompaniment of an additional clinician. No variables were associated with major adverse events in either cohort.

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“…In 2015, Extracorporeal Life Support Organization (ELSO, Ann Arbor, MI, USA; www.elso.org) published guidelines for ECMO transport team implementation. 17 Nwozuzu et al 18 demonstrated the significant discrepancies in the inclusion of anesthesiologist/intensivist on mobile ECMO teams, with European centers more likely to incorporate them into the team. To our point of view, inclusion of a specialized anesthesiologist/intensivist into the pediatric mobile ECMO team is absolutely essential.…”

Section: Discussionmentioning

confidence: 99%

Mobile extracorporeal membrane oxygenation for children: single-center 10 years’ experience

et al. 2019

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Objectives: Extracorporeal membrane oxygenation has become a gold standard in treatment of severe refractory circulatory and/or pulmonary failure. Those procedures require gathering of competences and material. Therefore, they are conducted in a limited number of reference centers. Emergent need for such treatments induces either hazardous transfers or a mobile pediatric extracorporeal membrane oxygenation team able to remote implantation and transportation. The aim of this work is not to focus on pediatric extracorporeal membrane oxygenation outcomes or indications, which have been extensively discussed in the literature. This study would like to detail the implementation, safety, and feasibility, even in a middle-size pediatric cardiac surgery reference center. Patients: This is a retrospective analysis of a series of patients initiated on extracorporeal membrane oxygenation in a peripheral center and transferred to a reference center. The data were collected from 10 consecutive years: from 2006 to 2016. Results: A total of 57 pediatric patients with a median weight of 6.00 (3.2-14.5) kg and median age of 2.89 (0.11-37.63) months were cannulated in peripheral center and transported on extracorporeal membrane oxygenation. We did not experience any adverse event during transport. The outcomes were comparable to our literature-reported on-site extracorporeal membrane oxygenation series with 42 patients (74%) weaned from extracorporeal membrane oxygenation and a 30-day survival of 60%. Neither patient’s age nor weight, indication for extracorporeal membrane oxygenation or length of transport, was statistically significant in terms of outcomes. Conclusion: Offsite extracorporeal membrane oxygenation implantation and ground or air transport for pediatric patients on extracorporeal membrane oxygenation appeared to be safe when performed by a dedicated and experienced team, even within a mid-size center.

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Mobile Extracorporeal Membrane Oxygenation Teams: The North American Versus the European Experience

Cited by 25 publications

References 34 publications

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

ECMO Transport without Physicians or Additional Clinicians

Mobile extracorporeal membrane oxygenation for children: single-center 10 years’ experience

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