Transportation of patients with severe respiratory failure on ECMO support. Four-year experience of a single ECMO center

Background
Acute respiratory distress syndrome (ARDS) is associated with high mortality despite advances in the field of critical care, including growing implementation of veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. The primary aim of this study was to present complications during transport on V-V ECMO support from regional hospitals to a tertiary center. The secondary goal was to identify initial laboratory and demographic data differentiating survivors and non-survivors.

Material and methods
This was a retrospective, single-center, case-series study. We extracted data from the hospital’s ECMO database from March 2016 to June 2019. Patients’ diagnosis at admission, baseline demographics, the Sequential Organ Failure Assessment (SOFA) and the Respiratory ECMO Survival Prediction (RESP) scoring systems, laboratory parameters at admission, duration of ECMO therapy and mechanical ventilation time, and the patient survival rate until the ICU discharge were analyzed.

Results
We assessed 31 patients retrieved from regional intensive care units. All analyzed transports on V-V ECMO were performed by an ambulance and median distance and transport time were 100 kilometers and 70 minutes, respectively. Minor complications during the transport were reported in 10 cases (32.25%). The mean V-V ECMO support time was 6.56 days and survival rate until the patient discharge was 64.51%. We found higher body mass index (33.5 vs. 26.5, P = 0.00251) and lower serum lactate level (1.25 vs. 1.6, P = 0.0058) at V-V ECMO initiation to correlate with higher survival rates.

Conclusions
The transport of patients on V-V ECMO support appears to be safe and feasible. Further studies are needed to identify the specific clinical conditions which might affect the final outcomes.