Outcome Comparison in Children Undergoing Extracorporeal Life Support Initiated at a Local Hospital by a Mobile Cardiorespiratory Assistance Unit or at a Referral Center*

D'Aranda, Erwan; Pastène, Bruno; Ughetto, Fabrice; Cotté, Jean; Esnault, Pierre; Fouilloux, Virginie; Mazzeo, Cécilia; Mancini, Julien; Lebel, Stéphane; Paut, O.

doi:10.1097/pcc.0000000000000897

Cited by 10 publications

(3 citation statements)

References 28 publications

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“…Finally, our institution demonstrated that there was no difference in terms of outcome between children undergoing ECMO initiated at a local hospital versus referral center. 19 This work supports the validity and the reliability of our mobile ECMO program.…”

Section: Discussionsupporting

confidence: 76%

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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Section: Discussionsupporting

confidence: 76%

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

et al. 2019

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“…Therefore, these patients should be transferred precociously to an ECMO center. Another suitable option is early retrieval by an ECMO team using a mobile ECMO service, especially for newborns with pulmonary hypertension and right ventricular failure [4].…”

Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock: more than 15 years of learning

et al. 2018

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Patients with refractory septic shock should be transferred precociously to a referral ECMO center. However, therapy should be used with caution in patients with vasoplegic pattern shock or S. pneumoniae sepsis. What is Known: • Children with refractory septic shock have significant mortality rates, and although ECMO is recommended, overall survival is low. • There are no studies regarding characteristics of infections as predictors of pediatric survival in ECMO. What is New: • Septic children should be transferred precociously to referral ECMO centers during the first hours if patients do not respond to conventional therapy. • Treatment should be used with caution in patients with vasoplegic pattern shock or S. pneumoniae sepsis.

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“…Le premier critère pour évaluer l'utilité de ces UMAC a été de comparer la survie des patients implantés par une équipe d'UMAC puis transportés vers un centre référent avec la survie des patients implantés directement dans un centre référent en assistance extracorporelle. L'ensemble des publications s'accordent à dire que la probabilité de survie d'un patient ayant nécessité l'implantation d'une assistance extracorporelle par une UMAC est la même que celle des patients directement implantés dans un centre référent [19]. La survenue de décès en cours de transport a aussi largement été étudiée, et le taux de décès en cours de transport décrit est faible [22,[30][31][32].…”

Section: Résultats Et Complicationsunclassified

Unité mobile d’assistance circulatoire et respiratoire de l’enfant et du nouveau-né : une revue narrative

Starck

Genuini

Hervieux

et al. 2021

Ann. Fr. Med. Urgence

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Les unités mobiles d’assistance circulatoire et respiratoire de l’enfant et du nouveau-né se sont développées au cours des dix dernières années. En effet, la mise en place d’une suppléance extracorporelle respiratoire ou circulatoire nécessite une équipe expérimentée et n’est pas disponible dans tous les centres hospitaliers pédiatriques. Or, les enfants atteints d’une défaillance circulatoire ou respiratoire réfractaire ne sont, pour la plupart, pas déplaçables vers une unité délivrant ce type de traitement de sauvetage. Les unités mobiles ont donc pour objectif de mettre à disposition ces technologies d’exception sur l’ensemble du territoire afin de garantir une égalité d’accès aux soins. Cependant, la haute technicité de ces thérapeutiques nécessite une équipe entraînée sachant poser et régler une assistance extracorporelle, prendre en charge un patient en défaillance respiratoire et/ou hémodynamique réfractaire et aguerrie à ces transports à haut risque. Le territoire français était jusqu’en 2014 très mal couvert par les unités mobiles pédiatriques et néonatales. Depuis, la création de plusieurs unités a permis une couverture totale du territoire. L’objectif de cette revue narrative sur les unités mobiles pédiatriques et néonatales est de résumer les différentes modalités de suppléance respiratoire et hémodynamique extracorporelle, d’en illustrer leurs différentes missions et leurs modalités de fonctionnement. Nous finirons par une description de leur efficacité en termes de survie et de survenue d’incidents en cours de transport.

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Outcome Comparison in Children Undergoing Extracorporeal Life Support Initiated at a Local Hospital by a Mobile Cardiorespiratory Assistance Unit or at a Referral Center*

Abstract: Extracorporeal life support can be safely initiated at children's bedside in the local hospital and then transported to the specialized referral center. Our results support the validity of an interregional organization of mobile cardiorespiratory assistance unit teams.

Cited by 10 publications

References 28 publications

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

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

Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock: more than 15 years of learning

Unité mobile d’assistance circulatoire et respiratoire de l’enfant et du nouveau-né : une revue narrative

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