Primary neonatal and pediatric ECMO transport: First experience in Spain.

Abstract

The organization of primary Extracorporeal membrane oxygenation (ECMO) transport is highly variable. To present the experience of the first mobile pediatric ECMO program in Spain, we designed a prospective descriptive study of all primary neonatal and pediatric (0-16years) ECMO transports carried out over 10years. The main variables recorded include demographic information, patient background, clinical data, ECMO indications, adverse events, and main outcomes. 39 primary ECMO transports were carried out with a 66.7% survival to hospital discharge. The median age was 1.24months[IQR: 0.09-96]. Cannulation was mostly peripheral venoarterial (33/39). The mean response time from the call from the sending center to the departure of the ECMO team was 4h[2.2-8]. The median inotropic score at the time of cannulation was 70[17.2-206.5], with a median oxygenation index of 40.5[29-65]. In 10% of the cases, ECMO-CPR was performed. Adverse events occurred in 56.4%, mostly related to the means of transport (40% overall). On arrival at the ECMO center, 44% of the patients underwent interventions. The median PICU stay was 20.5days[11-32]. 5 patients developed neurological sequels. Statistically significant differences between survivors and deceased patients were not found. A good survival rate, with a low prevalence of serious adverse events, suggests a clear benefit of primary ECMO transport when conventional therapeutic measures are exhausted and the patient is too unstable to undergo conventional transport. A nationwide primary ECMO-transport program must therefore be offered to all patients regardless of their location.