The Evolution of Interhospital Extracorporeal Membrane Oxygenation Transport: An Update from a Single Institution Continuing to Perform Mobile ECMO Through Another Decade

Background: Extracorporeal membrane oxygenation (ECMO) has become a widely recognized therapeutic option for patients with cardiac and/or respiratory failure, but there are still a limited number of pediatric ECMO centers that provide mobile ECMO transportation services. We report an update on our institution’s continued experience with interhospital ECMO transport from 2008-2019.

Methods: We performed a retrospective review of all patients undergoing interhospital ECMO transport by the Arkansas Children’s Hospital (ACH) ECMO team. Data points (age, diagnosis, ECMO course, hospital course, mode of transport, and outcome) were obtained and compared with the most recent Extracorporeal Life Support Organization (ELSO) registry report. When data permitted, comparisons were made across all three groups. Normally distributed variables were presented using mean and standard deviation (SD) and were assessed using either a one-way ANOVA (>2 groups) or a t-test (2 groups). Non-normally distributed variables were presented using median and interquartile range (IQR) and tested using either a Kruskal-Wallis test (>2 groups) or a Mann-Whitney test (2 groups). Categorical variables were presented using counts and percentages. Variables with small cell sizes (20% of cells ≤ 5) were assessed using a Fisher’s exact test. A Chi-squared test was used for all other categorical variables.

Results: Interhospital ECMO transport was provided 50 times by an ACH team from 2008 to 2019. Five were transfers between outside facilities (TAXI group); 5 were transports from our hospital to an outside facility (OUT group); 40 were transports to our hospital (RETURN group). Transport was by helicopter (34%), fixed wing (52%), and ground (14%). No patients died during transport. Indications for ECMO were cardiac failure in 73%, neonatal respiratory failure in 6%, and other respiratory failure in 21%. Overall survival from ECMO for the RETURN group was 75% (30 of 40); overall survival to discharge was 65% (26 of 40). Patients with cardiac failure had a 55% (16 of 29) rate of survival to discharge. Neonates with respiratory failure had a 100% (1 of 1) rate of survival to discharge. Other patients with respiratory failure had a 90% (9 of 10) rate of survival to discharge. None of these survival rates were statistically different from survival rates for in-house ECMO patients or for survival rates reported in the international ELSO registry (p > .1 for all comparisons).

Conclusion: Outcomes of patients transported by an experienced ECMO team are comparable to those of non-transported ECMO patients at our institution and in the ELSO registry. As previously reported, interhospital ECMO transport is both safe and feasible. With technological advances in both ECMO and transport equipment, and an increasing number of ECMO centers, we look forward to the development of more regional mobile ECMO programs to be able to deliver advanced care throughout all areas of the country.