Does Transport Time or Distance from Hospital Affect Survival in Extracorporeal Membrane Oxygenation (ECMO) Patients?

Abstract

Purpose Many hospitals in the United States are limited in their capabilities to treat advanced heart disease. This limitation results in patients needing to be transferred to a facility with the capacity to provide higher levels of care when ECMO support has been initiated. In this study we aim to look at whether transport time or distance impacts survival rate of implanted ECMO patients. Methods The Artificial Heart Program's database at Intermountain Medical Center was queried from June 2007 - 2017 for patients transported to the Intermountain facility on ECMO. Patients were stratified into two groups. Group 1: those who survived to discharge and Group 2: those who expired before discharge. Seven parameters were evaluated for significance: age, distance transported, time from initial request to arrival, transport time, whether chest compressions were performed, indication for support and type of support. A two-sample t-test was used to determine significance. Results 50 patients met study inclusion criteria; 29 were male and 21 were female. The average age for Group 1 was 49±13 years compared to Group 2, 55 ± 15 years. The average transport distance and time was 125±118 miles & 73±24 minutes for Group 1 vs 74±78 miles & 105±55 minutes for Group 2. The time from life flight request was 293±85 minutes vs 365±139 minutes for Group 1 vs Group 2. The majority of patients were implanted with CARDIOHELP (CH) (p=0.52). Additional preliminary factors such as indications for support and whether patient received chest compressions are summarized below. Conclusion Our observations indicate that increased transport time correlates with a lower survival rate. Whereas we found no significance in the distance the patient traveled. The average distance for Group 1 was 40% farther then Group 2. This study suggests that decreasing the time from ECMO request to transportation arrival and decreasing the time of transport could lead to improved survival of ECMO patients transferred between hospitals.