Patient Safety during ECMO Transportation: Single Center Experience and Literature Review

Abstract

Background. Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. Aim. The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. Methods. A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. Results. Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2–63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5–200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). Conclusions. Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety.

Comprehensive assessment of a nationwide simulation-based course for artificial life support

“…The effectiveness of translational medicine is confirmed by authors in many areas of application of extracorporeal techniques and in transporting critically ill patients. The simulation activities presented by the authors allowed for the creation of algorithms for proceedings in the regional program "ECMO for Greater Poland" [5- 13,19,20]. Additional studies are needed to determine if simulation training will reduce complication rate and improve patients' outcomes [21][22][23].…”

“…The most important aspect for patient with ECMO support transportation safety is a well trained and cooperating dedicated ECMO team. In Broman et al's survey, 14 of 15 centers performed programs for structured training-33% provided full ECMO clinical and ECMO transport training, (i.e., simulations, rescue training aircraft); 60% regular ECMO simulations, 20% annual transport simulations, 33% others performed ECMO pump training and in-house simulations [20].…”

“…"ECMO for Greater Poland" as Artificial Life Support HUB coordinator body in the dedicated R&D Innovation Ecosystem (Fig 6) also has an educational arm of the project [20,[29][30][31][32][33][34][35]. The additional knowledge dissemination in the "ECMO for Greater Poland" Program is realized mainly through different scientific articles (also in interdisciplinary teams) in reputed scientific journals, presentations on different national and international conferences, as well as through organizing the international conferences "ECMO for Greater Poland" in Poznań (Poland) in 2017 and 2019, which met with high recognition in the community.…”

“…This center is unique in Poland and in the Central and Eastern Europe region-under ELSO auspicious. The authority of this organization is still improved in recent difficult year and resulted in the proper guidelines in intensive and critical care of ECMO supported patients [20]. Thanks to ELSO's trust, the project gained recognition from the Organization and during the first meeting in 2019 it was positively certified and obtained the status of ELSO-endorsed course.…”

Mobile ECMO retrieval of patients during the COVID‐19 pandemic

“…4 Occasionally, patients requiring ECMO support must be transferred after out-of-center initiation of ECMO by a mobile ECMO retrieval team. 5 While this approach has been successfully established in various ECMO centers before the outbreak of the COVID-19 pandemic, data on the feasibility and the results of out-of-center initiation of ECMO during the pandemic are scarce. 6 We report single-center retrospective data of COVID-19 patients supported with ECMO in our center after outof-center initiation of ECMO and patient transfer by our ECMO retrieval team.…”