Transport of Critically Ill Patients in need of Extracorporeal Life Support

Day, Susan; Chapman, Robin A.

doi:10.1016/s0749-0704(18)30242-2

Cited by 8 publications

(3 citation statements)

References 52 publications

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“…As with other centers, we are using a ground ambulance which is equipped for intensive care and monitoring. [8][9][10] If necessary, the ambulance can be moved into the Hercules. This arrangement allows the patient to stay in the ambulance during the entire transportation.…”

Section: Discussionmentioning

confidence: 99%

Transportation of critically ill patients on extracorporeal membrane oxygenation

et al. 2008

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Serious pulmonary and cardiac failure may be treated with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails. In some severely ill patients, it may be necessary to initiate ECMO at the local hospital and, thereafter, transport the patient back to the ECMO center. The aim of this study was to evaluate our experiences with transportation of patients on ECMO. From Oct 1992 to Jan 2008 23, patients were transported on ECMO from local hospitals to Rikshospitalet. The study included seventeen patients with pulmonary failure and four patients with cardiac failure. All age groups were represented. Aircraft were used in 17 cases, ground vehicles in six. The times from decision until ECMO was established, the time from ECMO to departure from the local hospital and the transportation time were registered. All transportations were uneventful. After 10.3 +/-6.7 days, six patients died on ECMO and another patient died within 30 days. Mean ECMO time for those who died was 13.3 +/- 9.6 vs. 8.5 +/- 4.7 days for survivors, p=0.34. Seventeen patients were able to be successfully weaned from ECMO. Thirty day survival was 67%. The mean age for survivors was 15.3+/-18.3 (range 0-54.6) vs. 23.6 +/- 20.3 years (range 0-55.9) in fatal cases, p=0.41. The time from referral to initiating ECMO was a mean of 7.32 +/- 2.3 (3.0-12.0) hours for survivors vs. 7.88 +/- 3.0 (3.50-13.40) hours for non- survivors, p=0.76. The time from initiating ECMO to departure was 5.1 +/- 6.5 (0.58-23.75) hours in survivors vs. 9.1 +/- 6.8 (0.55-18.45) hours in non-survivors, p=0.18. Time from departure to arrival at Rikshospitalet was a mean of 3.2 (0.50-5.10) hours for survivors versus 2.5 (0.5-4.40) for non-survivors, p=0.41. This study shows that ECMO can be successfully established at local hospitals, using an experienced team, and that transportation of patients on ECMO can be performed safely and without technical difficulties. Survival for this group of patients did not differ from patients treated at the ECMO center.

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Section: Discussionmentioning

confidence: 99%

Transportation of critically ill patients on extracorporeal membrane oxygenation

et al. 2008

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“…Patients identified as candidates for more invasive critical care services will achieve maximum benefit if transfer occurs early in the course of their disease process. 21 All transports are governed by EMTALA, which assures that transports are appropriate and that necessary procedures and records are satisfied. Preplanning, team coordination, and transfer facilitation all contribute to program success and quality patient care throughout all aspects of the transport process.…”

Section: Resultsmentioning

confidence: 99%

Interfacility Transports

Blackwell¹

2002

Semin Respir Crit Care Med

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Financial pressures exerted by managed care organizations toward hospitals to improve efficiencies and to lower total healthcare costs continue to force physicians and administrators to reevaluate operations and practices. This shifting of risk exposure from insurers to providers has resulted in many mergers, acquisitions, and affiliations, so as to form integrated health systems that reduce repetition and duplication of services. Therefore, as these integrated systems develop, along with the emergence of tertiary care, regional referral, and specialty hospitals, the need for patient transfers between such facilities will expand. The decision to move patients between facilities is a multicomponent process comprising health, safety, financial, and legal concerns. Interfacility transportation of patients has been performed over the past 20 to 30 years. Whereas ground transport services were prominent in the 1970s, air medical programs using helicopters and fixed-wing aircraft have recently become widespread. Both hospital-based and private agencies have continued to develop programs for efficiently and expeditiously transporting critically ill or injured patients, many requiring complex life-support devices. The Practice Management Committee of the American College of Emergency Physicians recently updated the 1990 policy statement on interfacility transfers, and two position statements are available from the National Association of EMS Physicians on criteria for air medical transport and medical direction for interfacility transport services. This review provides an overview of transportation systems and services available and assists physicians in understanding the various modes and characteristics of systems available. Personnel configurations and capabilities, physiological limitations, inherent requirements for equipment and patient preparation, and legal issues involved with transferring patients are also outlined.

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“…For example, according to Day et al, “transport teams should be thoroughly familiar with the pathophysiology of cardiac and respiratory failure. They should be equipped to continue the monitoring and treatment initiated at the referring center, to maintain that level of care during transfer, and to treat complications of the diseases or of the therapy itself.” 32 Studies showed that significant life-threatening cardiopulmonary changes can occur during patient transport, and cardiac or critical-care-trained anesthesiologists deal with these issues as a part of their daily clinical responsibility. 4 Thus, it may be prudent to use their expertise during interhospital transport of ECMO patients.…”

Section: Discussionmentioning

confidence: 99%

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

Nwozuzu

Fontes

Schonberger

2016

Journal of Cardiothoracic and Vascular Anesthesia

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Objective To evaluate differences in the inclusion of anesthesiologists in mobile extracorporeal membrane oxygenation (ECMO) teams between North American and European centers. Design A retrospective review of North American versus European mobile ECMO teams. The search terms used to identify relevant articles were the following: “extracorporeal membrane transport,” “mobile ECMO,” and “interhospital transport.” Setting MEDLINE review of articles. Participants None. Interventions None. Results Between 1986 and 2015, 25 articles were published that reported the personnel makeup of mobile ECMO teams in North America and Europe: 6 from North American centers and 19 from European centers. The included articles reported a total of 1,329 cases: 389 (29%) adult-only cohorts and 940 (71%) mixed-age cohorts. Among North American studies, 0 of 6 (0%) reported the presence of an anesthesiologist on the mobile ECMO team in contrast to European studies, in which 10 of 19 (53%) reported the inclusion of an anesthesiologist (Fisher exact p for difference = 0.05). In terms of number of cases, this discrepancy translated to 543 total cases in North America (all without an anesthesiologist) and 499 cases in Europe (37%) including an anesthesiologist on the team (Fisher exact p for difference <0.001). Conclusions This study demonstrated significant geographic discrepancies in the inclusion of anesthesiologists on mobile ECMO teams, with European centers more likely to incorporate an anesthesiologist into the mobile ECMO process compared with North American centers.

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Transport of Critically Ill Patients in need of Extracorporeal Life Support

Cited by 8 publications

References 52 publications

Transportation of critically ill patients on extracorporeal membrane oxygenation

Transportation of critically ill patients on extracorporeal membrane oxygenation

Interfacility Transports

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

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