Transport on extracorporeal membrane oxygenation for congenital diaphragmatic hernia: A unique center experience
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In brief
In brief
Retrospective analysis of 40 ECMO transports for CDH patients over 22 years demonstrates safe long-distance transfer with 87% survival to discharge despite 40% complication rate. Median transport distance was 560 km with most transfers via fixed-wing aircraft, requiring highly trained personnel skilled in ECMO physiology and transport medicine.
Written by the GCMD Library team from the article.
Background
Support on Extracorporeal oxygenation membrane (ECMO) represents the last therapeutic option in the management of respiratory failure and pulmonary hypertension refractory to treatment in patients with congenital diaphragmatic hernia (CDH).
Aim
The objective of this work was to present our experience of all the cases of CDH that we have transported on ECMO.
Material and methods
Medical records of patients, national and international, with CDH transported by our service on ECMO from 1997 to 2018 were reviewed.
Results
During 22 years, we performed 40 ECMO transports of newborns with CDH, 39 primary and one secondary. In 10% (4/40) we transferred patients from their primary hospital after the implantation of cannulae and commencement of ECMO to another center abroad owing to the lack of beds in our unit. Twenty (50%) of the transports were from a foreign country. Median transport distance was 560 (428–1381) km and the median transport time was 4.5 (4.2–6.3) h.
The mode of transport was ground ambulance in 20%, helicopter in 10%, fixed wing aircraft in 62.5% and ground ambulance in Freight aircraft in 7.5%. In 40% of the transports, 20 complications occurred. In one of every four transports with complications, more than one event occurred.
Most frequent complication was loss of tidal volumes (35%) and in 30% of the complications another patient related event was recorded. Equipment failure occurred in 20%, and climate problems and transport vehicle problems in 15%. No deaths occurred during transport. Venoarterial ECMO was used in 39 of the 40 cases. Survival to discharge was 87% for the entire period and long-term survival was 77%.
Conclusions
Long and short distance interhospital transports of CDH patients on ECMO can be performed safely. Despite occurrence of adverse events, the risk of mortality is very low. The personnel involved must be highly competent in intensive care, physiology and physics of ECMO, cannulation, intensive care transport and air transport medicine. They must also be trained to recognize risk factors in these patients.
Level of evidence
III Retrospective cohort study.