Mobile ECMO unit – A single center experience

Abstract

Background: Transport of critically ill patients especially on extracorporeal membrane oxygenation (ECMO) is a real challenge. In India, more than 98% of cases requiring transfer are transported by road and less than 2% of cases are transported by air due to costs involved. As an institutional policy, and considering the safety and cost effectiveness, we have decided to develop mobile teams who can go to the patients, cannulate them, and stay during the course of the ECMO run. The mobile team program was established in 2010 when there were less than 10 ECMO centers in the country.1Methods: First, the ECMO intensivist talks to the referring physician to confirm the need for ECMO, and then the coordinator settles financial issues and organizes the team, equipment, and travel arrangements. The team composed of the nursing staff, perfusionist, and intensivist2 leaves within 2 hours of receiving the confirmation. Results: Retrospective analysis of patients managed on ECMO by our mobile ECMO team from August 2010 to August 2016 shows that we received 170 referrals. Of these, 132 calls were confirmed, but we initiated ECMO in 121 patients only (Table 1). We visited the eight Indian states, roughly 20 cities, and more than 50 tertiary care hospitals.3 Only four patients were in secondary care centers and were transferred to nearby tertiary care units after initiation of ECMO and stabilization. The average time from call confirmation to initiation of ECMO was 8 hours, with a minimum of 4 hours and a maximum of 14 hours, mainly depending on the availability of a transport modality.Table 1Overview of ECMO cases managed by our mobile ECMO team from August 2010 to August 2016.4 There was not much of mortality difference when ECMO is done in an ECMO center or when it is done by an expert mobile ECMO team out of the hospital. Problems encountered included: □ Forgetting part of the equipment or disposables in four cases, resulting in a 4-hour delay to ECMO initiation; □ Getting adjusted to a different environment, different culture, and language; □ Coordinating team work with an entire new team at the referring facility. Conclusions: In India, healthcare being self-sponsored, mobilizing the ECMO team and equipment is a favored approach to place a patient on ECMO, from a safety and cost effectiveness perspective (Table 2). This approach also helps create more awareness around the utilization of ECMO, and is a way of training and developing regional centers. Of the 50 tertiary care hospitals where we have done ECMO in the past, 13 have now developed their own ECMO unit and team.Table 2Overview of ECMO cases managed by our mobile ECMO team from August 2010 to August 2016.4