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ECMO Transport without Physicians or Additional Clinicians

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  30 October 2020

Anna Condella ,
Jeremy B. Richards ,
Michael A. Frakes ,
Christian J. Grant ,
Jason E. Cohen  and
Susan R. Wilcox Open the ORCID record for Susan R. Wilcox [Opens in a new window]
Anna Condella
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsUSA
Jeremy B. Richards
Affiliation:
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Michael A. Frakes
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Christian J. Grant
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Jason E. Cohen
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Department of Surgery, Brigham and Women’s Hospital, Boston, MassachusettsUSA
Susan R. Wilcox*
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsUSA Boston MedFlight, Bedford, MassachusettsUSA
*
Correspondence: Susan R. Wilcox, MD, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts02114USA, E-mail: [email protected]
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Abstract

Background:

Extracorporeal membrane oxygenation (ECMO) has accelerated rapidly for patients in severe cardiac or respiratory failure. As a result, ECMO networks are being developed across the world using a “hub and spoke” model. Current guidelines call for all patients transported on ECMO to be accompanied by a physician during transport. However, as ECMO centers and networks grow, the increasing number of transports will be limited by this mandate.

Objectives:

The aim of this study was to compare rates of adverse events occurring during transport of ECMO patients with and without an additional clinician, defined as a physician, nurse practitioner (NP), or physician assistant (PA).

Methods:

This is a retrospective cohort study of all adults transported while cannulated on ECMO from 2011-2018 via ground and air between 21 hospitals in the northeastern United States, comparing transports with and without additional clinicians. The primary outcome was the rate of major adverse events, and the secondary outcome was minor adverse events.

Results:

Over the seven-year study period, 93 patients on ECMO were transported. Twenty-three transports (24.7%) were accompanied by a physician or other additional clinician. Major adverse events occurred in 21.5% of all transports. There was no difference in the total rate of major adverse events between accompanied and unaccompanied transports (P = .91). Multivariate analysis did not demonstrate any parameter as being predictive of major adverse events.

Conclusions:

In a retrospective cohort study of transports of ECMO patients, there was no association between the overall rate of major adverse events in transport and the accompaniment of an additional clinician. No variables were associated with major adverse events in either cohort.

Keywords

adverse eventsextracorporeal membrane oxygenationresource allocationtransportation of patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 51 - 57
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

McCarthy, FH, McDermott, KM, Kini, V, et al. Trends in US extracorporeal membrane oxygenation use and outcomes: 2002-2012. Semin Thorac Cardiovasc Surg. 2015;27(2):81-88.CrossRefGoogle Scholar
Natt, BS, Desai, H, Singh, N, Poongkunran, C, Parthasarathy, S, Bime, C. Extracorporeal membrane oxygenation for ARDS: national trends in the United States 2008-2012. Respir Care. 2016;61(10):1293-1298.Google Scholar
Shah, M, Patnaik, S, Patel, B, et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol. 2018;107(4):287-303.CrossRefGoogle ScholarPubMed
Makdisi, G, Wang, I-W. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis. 2015;7(7):E166-176.Google ScholarPubMed
Richardson, ASC, Schmidt, M, Bailey, M, Pellegrino, VA, Rycus, PT, Pilcher, DV. ECMO cardio-pulmonary resuscitation (ECPR), trends in survival from an international multicenter cohort study over 12-years. Resuscitation. 2017;112:34-40.10.1016/j.resuscitation.2016.12.009CrossRefGoogle Scholar
Broman, LM. Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems. J Thorac Dis. 2017;9(9):3425-3429.10.21037/jtd.2017.07.93CrossRefGoogle ScholarPubMed
Combes, A, Brodie, D, Bartlett, R, et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190(5):488-496.10.1164/rccm.201404-0630CPCrossRefGoogle ScholarPubMed
Peek, GJ, Clemens, F, Elbourne, D, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006;6:163.10.1186/1472-6963-6-163CrossRefGoogle ScholarPubMed
Noah, MA, Peek, GJ, Finney, SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306(15):1659-1668.CrossRefGoogle Scholar
Broman, LM, Holzgraefe, B, Palmer, K, Frenckner, B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care. 2015;19:278.10.1186/s13054-015-0994-6CrossRefGoogle ScholarPubMed
Ranney, DN, Bonadonna, D, Yerokun, BA, et al. Extracorporeal membrane oxygenation and interfacility transfer: a regional referral experience. Ann Thorac Surg. 2017;104(5):1471-1478.10.1016/j.athoracsur.2017.04.028CrossRefGoogle ScholarPubMed
Biscotti, M, Agerstrand, C, Abrams, D, et al. One hundred transports on extracorporeal support to an extracorporeal membrane oxygenation center. Ann Thorac Surg. 2015;100(1):34-40.CrossRefGoogle Scholar
Austin, DE, Burns, B, Lowe, D, et al. Retrieval of critically ill adults using extracorporeal membrane oxygenation: the nine-year experience in New South Wales. Anaesth Intensive Care. 2018;46(6):579-588.CrossRefGoogle ScholarPubMed
Extracorporeal Life Support Organization (ELSO). Guidelines for ECMO Transport. Guidelines for ECMO Transport. https://www.elso.org/Portals/0/Files/ELSO GUIDELINES FOR ECMO TRANSPORT_May2015.pdf. Published 2015. Accessed May 5, 2019.Google Scholar
Niziolek, KC, Preston, TJ, Osborn, EC. Transport while on extracorporeal membrane oxygenation support. Crit Care Clin. 2017;33(4):883-896.10.1016/j.ccc.2017.06.009CrossRefGoogle ScholarPubMed
Javidfar, J, Brodie, D, Takayama, H, et al. Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center. ASAIO J. 2011;57(5):421-425.10.1097/MAT.0b013e3182238b55CrossRefGoogle ScholarPubMed
Grenda, DS, Moll, V, Kalin, CM, Blum, JM. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program. Ann Transl Med. 2017;5(4):71.10.21037/atm.2016.11.35CrossRefGoogle Scholar
Gutsche, J, Vernick, W, Miano, TA, Rescue, PL. One-year experience with a mobile extracorporeal life support service. Ann Thorac Surg. 2017;104(5):1509-1515.CrossRefGoogle ScholarPubMed
Ericsson, A, Frenckner, B, Broman, LM. Adverse events during inter-hospital transports on extracorporeal membrane oxygenation. Prehosp Emerg Care. 2017;21(4):448-455.10.1080/10903127.2017.1282561CrossRefGoogle ScholarPubMed
Fletcher-Sandersjoo, A, Frenckner, B, Broman, M. A single-center experience of 900 interhospital transports on extracorporeal membrane oxygenation. Ann Thorac Surg. 2019;107(1):119-127.10.1016/j.athoracsur.2018.07.040CrossRefGoogle ScholarPubMed
Wilcox, SR, Saia, MS, Waden, H, et al. Improved oxygenation after transport in patients with hypoxemic respiratory failure. Air Med J. 2015;34(6).CrossRefGoogle ScholarPubMed
Nwozuzu, A, Fontes, ML, Schonberger, RB. Mobile extracorporeal membrane oxygenation teams: the North American versus the European experience. J Cardiothorac Vasc Anesth. 2016;30(6):1441-1448.CrossRefGoogle ScholarPubMed
Wilhelm, MJ, Inderbitzin, DT, Reser, D, et al. Outcome of inter-hospital transfer of patients on extracorporeal membrane oxygenation in Switzerland. Swiss Med Wkly. 2019;149:w20054.Google ScholarPubMed
Fouilloux, V, Gran, C, Ghez, O, et al. Mobile extracorporeal membrane oxygenation for children: single-center 10 years’ experience. Perfusion. 2019;34(5):384-391.10.1177/0267659118824006CrossRefGoogle ScholarPubMed
Ehrentraut, SF, Schroll, B, Lenkeit, S, et al. Interprofessional two-man team approach for interhospital transport of ARDS-patients under extracorporeal membrane oxygenation: a 10 years retrospective observational cohort study. BMC Anesthesiol. 2019;19(1):19.10.1186/s12871-019-0687-9CrossRefGoogle ScholarPubMed
Critical Care Transport Standards. Version 1.0 ed. Association of Critical Care Transport; 2016. https://nasemso.org/wp-content/uploads/ACCT-Standards-Version1-Oct2016.pdf. Accessed June 2019.Google Scholar
Adalja, AA, Watson, M, Waldhorn, RE, Toner, ES. A conceptual approach to improving care in pandemics and beyond: severe lung injury centers. J Crit Care. 2013;28(3):318.10.1016/j.jcrc.2012.09.016CrossRefGoogle ScholarPubMed