One-Year Experience With a Mobile Extracorporeal Life Support Service

Abstract

Background Severe acute respiratory distress syndrome (ARDS) is associated with high mortality. The International Extracorporeal Membrane Oxygenation network recommends regionalization of extracorporeal life support (ECLS) to high volume centers and development of mobile ECLS teams to rescue patients with severe acute respiratory disease. Methods A tertiary medical center developed a mobile team and the infrastructure to support a 24/7 ECLS transport service. We conducted a retrospective study of all consecutive patients presenting for ECLS for severe ARDS from outside hospitals through our mobile ECLS program associated with hemodynamic instability from Jan 1, 2015 until December 31st, 2015. Results During the study period, 106 consults for ECLS were received and 36 patients were placed on ECLS. Of these 36 ECLS patients, 11 were deemed stable enough for transport prior to ECLS, and 21 required mobile ECLS by the mobile ECLS, with a survival of 67% (14/21). The other 4 ECLS patients were in-house patients and thus received ECLS in a non-mobile fashion. In addition, 28 patients were transferred to our hospital who did not receive ECLS. Patient survival increased significantly with increased experience of the program, as the highest mortality rates were early in the program (p=0.006) and in conjunction with stricter adherence to our exclusion criteria. Conclusions The formation of a mobile ECLS program is a complex undertaking which took two years of planning to develop. Development of criteria for ECLS implementation can guide appropriate resource utilization and may prevent use in patients with little to no chance of survival.

A Case Series of Devastating Intracranial Hemorrhage During Venovenous Extracorporeal Membrane Oxygenation for COVID-19

“… 6 , 7 A decision was made to continue using VV ECMO during the COVID-19 pandemic with rigorous, multidisciplinary patient selection. Due to limited access to ECMO circuits and concern about an overwhelming number of consults for ECMO, the authors restricted the authors’ previously published criteria 8 to the following: Age <65 Absence of significant pre-existing comorbidities Mild or no limitations in physical activity prior to COVID-19 No or mild evidence of other end-organ damage from current disease Body mass index <45 (relative indication) Smoking history <30 packs/yr No cardiac arrest prior to cannulation Ventilator duration < or = 7 days …”

Outcomes of out-of-hospital extracorporeal membrane oxygenation transfers: significance of initiation site and personnel

“…10 This survival rate was most likely due to the early detection and treatment of technical ECMO complications and the strict patient inclusion and exclusion criteria as the previous study reported. 9 Our study similarly incorporated strict criteria, which is demonstrated in the data from referral hospitals consultations in Table 4. The major contraindications of each rejected ECMO transfer referrals are listed.…”

“…Their findings supported the safety of the procedure with a survival of 67%. 9 Patients in our study were transferred to TJUH on ECMO or indicated for cannulation upon arrival. Our ECMO survival rate was comparable with previous reports and the national ECMO survival rate (68%).…”

“…An ECMO transfer study by Ranney et al 1 demonstrated promising results for both survival to decannulation rate and discharge rate for both VA- and VV-ECMO (ECMO survival: 66% in VA-ECMO vs. 77% in VV-ECMO; hospital survival rate: 48% in VA-ECMO vs. 70% in VV-ECMO, respectively). A study by Gutche et al 9 focused on the clinical outcomes of mobile ECMO, which only incorporated VV-ECMO. Their findings supported the safety of the procedure with a survival of 67%.…”

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

“…Consultation and patient selection are critical parts of the program. 64,82,83 Organizational requirements, ECPR recommendations, and algorithms have been published. 80,82 Through initial experiences by mobile ECMO teams, data are emerging on the profile of patients who will benefit more from mobile ECMO: younger patients (<60 years); patients with no flow time of fewer than 5 minutes; and patients with a shockable rhythm, sufficient CPR, and ECMO implantation time of 60 minutes.…”