Abstract
BackgroundExtra Corporeal Membrane Oxygenation (ECMO) has become an accepted treatment option for severely ill patients. Due to a limited availability of ECMO support therapy, patients must often be transported to a specialised centre before or after cannulation. According to the ELSO guidelines, an ECMO specialist should be present for such interventions. Here we describe the safety and efficacy of a reduced team approach involving one anaesthesiologist, experienced in specialised intensive care medicine, and a specialised critical care nurse.MethodsThis study is a 10 years retrospective, single institution analysis of all data collected between January 2007 and December 2016 from the medical records at the University Hospital Bonn, Germany.ResultsThe Bonner mobile ECMO team was deployed in 170 cases for on-site evaluation for ECMO support therapy. 4 (2.4%) patients died prior to arrival or during the implementation of ECMO support. Of the remaining 166 patients, 126 were cannulated at the referring site, 40 were transported without ECMO. Of those, 21 were subsequently cannulated out our centre. 19 patients never received ECMO treatment. The primary indication for ECMO treatment was ARDS (159/166 patients). Veno-venous ECMO was initiated in 137, whilst 10 patients received veno-arterial ECMO treatment. Mean transportation time was 75 ± 36 min, and mean transport distance was 56 ± 57 km. In total, 26 complications were observed, three being directly transport-related. The overall survival was 55%.ConclusionsInitiation of extracorporeal membrane oxygenation and subsequent transport can be safely and efficiently performed by a two-man team with good outcome.
Highlights
Extra Corporeal Membrane Oxygenation (ECMO) has become an accepted treatment option for severely ill patients
This paper aims to describe the safety and efficacy of a reduced team approach for performing primary transports of ECMO patients over a ten-year time frame
One patient died during ECMO cannulation. 30 (18,1%) patients were transported by the ECMO team without ECMO implantation
Summary
Extra Corporeal Membrane Oxygenation (ECMO) has become an accepted treatment option for severely ill patients. Due to a limited availability of ECMO support therapy, patients must often be transported to a specialised centre before or after cannulation. The availability of this ECMO is still restricted to specialised centres Due to this limited availability, either transport of critical ill patients to the ECMO centre prior to cannulation or retrieval under ECMO support is necessary. There are very few studies available reporting large numbers of interfacility transports on ECMO support These have been performed at only a few programs with a great variability of team composition [4,5,6]. According to the Extracorporeal Life Support Organization (ELSO) General Guidelines, transport teams comprise of a cannulating physician, ECMO physician, ECMO specialist, transport nurse, and transport respiratory therapist [7]. There are no national standards for the exact composition of ECMO transport teams for primary transports, i.e. initiation of ECMO at the referring site and subsequent transport to the dedicated ECMO centre
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