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International Survey on Extracorporeal Membrane Oxygenation Transport

Broman, Lars Mikael*,†,‡; Dirnberger, Daniel R.§,¶; Malfertheiner, Maximilian V.‡,‖; Aokage, Toshiyuki#; Morberg, Pål**; Næsheim, Torvind**; Pappalardo, Federico††,‡; Di Nardo, Matteo‡‡,‡; Preston, Tom§§; Burrell, Aidan J.C.¶¶; Daly, Ivonne‖‖; Harvey, Chris##; Mason, Phillip***; Philipp, Alois†††; Bartlett, Robert H.‡‡‡; Lynch, William§§§; Belliato, Mirko¶¶¶,‡; Taccone, Fabio Silvio‡,‖‖‖

doi: 10.1097/MAT.0000000000000997
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Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for severe respiratory and circulatory failure. It is best performed in high-volume centers to optimize resource utilization and outcomes. Regionalization of ECMO might require the implementation of therapy before and during transfer to the high-volume center. The aim of this international survey was to describe the manner in which interhospital ECMO transport care is organized at experienced centers. Fifteen mobile ECMO centers from nine countries participated in this survey. Seven (47%) of them operated under the “Hub-and-Spoke” model. Transport team composition varies from three to nine members, with at least one ECMO specialist (i.e., nurse or perfusionist) participating in all centers, although intensivists and surgeons were present in 69% and 50% of the teams, respectively. All centers responded that the final decision to initiate ECMO is multidisciplinary and made bedside at the referring hospital. Most centers (75%) have a quality control system; all teams practice simulation and water drills. Considering the variability in ECMO transport teams among experienced centers, continuous education, training and quality control within each organization itself are necessary to avoid adverse events and maintain a low mortality rate. A specific international ECMO Transport platform to share data, benchmark outcomes, promote standardization, and provide quality control is required.

*Department of Pediatric Perioperative Medicine and Intensive Care, ECMO Centre Karolinska, Karolinska University Hospital;

Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden;

European ECMO Advisory Board;

§Division of Neonatology Nemours, Department of Pediatrics, Alfred I. duPont Hospital for Children Wilmington, Wilmington, Delaware;

San Antonio Military Medical Center/Wilford Hall Medical Center, San Antonio, Texas;

Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany;

#Critical Care and Emergency Medicine, Tokyo Metropolitan Children’s Medical Centre, Tokyo, Japan;

**Department of Cardiothoracic Anesthesia, University Hospital of North Norway, Tromsö, Norway;

††Advanced Heart Failure and Mechanical Circulatory Support Program, Department of Cardiothoracic Anesthesia and Intensive Care, Vita Salute San Raffaele University, Milan, Italy;

‡‡Pediatric Intensive Care Unit, Children’s Hospital Bambino Gesù, IRCCS, Rome, Italy;

§§Innovative ECMO Concepts Inc., Arcadia, Oklahoma;

¶¶Department of Intensive Care, The Alfred Hospital, Melbourne, Australia;

‖‖Legacy Emanuel Medical Center, Randall Children’s Hospital, Portland, Oregon;

##Glenfield Hospital, Leicester, United Kingdom;

***Department of Surgery, San Antonio Military Medical Center, San Antonio, Texas;

†††ECMO Center, University Medical Center Regensburg, Regensburg, Germany;

‡‡‡Department of Surgery, University of Michigan, Ann Arbor, Michigan;

§§§Section of Thoracic Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, Michigan;

¶¶¶U.O.C. Anestesia e Rianimaizone 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and

‖‖‖Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, ULB, Brussels, Belgium.

Submitted for consideration April 2018; accepted for publication in revised form March 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Ethics: Since this report is a retrospective descriptive study of organizational structure, no data related to any specific patient was handled, and ethical approval was waived.

Availability of data and material: The datasets supporting the conclusions of this article are included within the article and its Additional files; http://links.lww.com/ASAIO/A409.

L.M.B. designed the concept, collected, analyzed and interpreted the data, drafted the manuscript, and approved the final version for submission. D.R.D., M.V.M., T.A., Pål Morberg, T.N., F.P., M.D.N., T.P., A.J.C.B., I.D., C.H., Phllip Mason, A.P., R.H.B., W.L., M.B., and F.S.T. collected, analyzed and interpreted the data, co-wrote and critically revised the manuscript and approved the final version for submission.

Correspondence: Lars Mikael Broman, ECMO Centre Karolinska, Karolinska University Hospital, 171 76 Stockholm, Sweden. Email: lars.broman@sll.se.

Copyright © 2019 by the American Society for Artificial Internal Organs