Benjamin Bryner1, Elaine Cooley2, William Copenhaver2, Kristin Brierley3, Nicholas Teman3, Denise Landis4, Peter Rycus5, Mark Hemmila3, Lena M Napolitano3, Jonathan Haft6, Pauline K Park3, Robert H Bartlett3. 1. Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: bbryner@med.umich.edu. 2. Extracorporeal Membrane Oxygenation Program, University of Michigan Health System, Ann Arbor, Michigan. 3. Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan. 4. Survival Flight, University of Michigan Health System, Ann Arbor, Michigan. 5. Extracorporeal Life Support Organization, Ann Arbor, Michigan. 6. Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Abstract
BACKGROUND: Interfacility transport of patients on extracorporeal membrane oxygenation (ECMO) has been performed in large numbers at only a few programs. Limited data are available on outcomes after ECMO transport to justify expanding or discontinuing these programs. METHODS: This was a retrospective review of a 20-year, single-institution experience with interhospital ECMO transport as well as a systematic review of reports of transfers of patients on ECMO. Results of both were compared with historical data from the international registry of the Extracorporeal Life Support Organization (ELSO). RESULTS: Between 1990 and 2012, ECMO was used to facilitate transport of 221 patients to our institution, and 135 (62%) survived to discharge. Review of an additional 27 case series describing ECMO transport of 643 patients showed an overall survival of 61%. After stratifying by age and primary indication for ECMO, survival of transported patients was not significantly different compared with all ECMO patients in the ELSO registry, with the exception of pediatric patients treated for respiratory failure (transported patients in this category had higher survival than those in the ELSO registry). CONCLUSIONS: Interfacility transport on ECMO is feasible and can be accomplished safely in the critically ill. Survival of transported patients is comparable to age-matched and treatment-matched ECMO patients at large.
BACKGROUND: Interfacility transport of patients on extracorporeal membrane oxygenation (ECMO) has been performed in large numbers at only a few programs. Limited data are available on outcomes after ECMO transport to justify expanding or discontinuing these programs. METHODS: This was a retrospective review of a 20-year, single-institution experience with interhospital ECMO transport as well as a systematic review of reports of transfers of patients on ECMO. Results of both were compared with historical data from the international registry of the Extracorporeal Life Support Organization (ELSO). RESULTS: Between 1990 and 2012, ECMO was used to facilitate transport of 221 patients to our institution, and 135 (62%) survived to discharge. Review of an additional 27 case series describing ECMO transport of 643 patients showed an overall survival of 61%. After stratifying by age and primary indication for ECMO, survival of transported patients was not significantly different compared with all ECMO patients in the ELSO registry, with the exception of pediatric patients treated for respiratory failure (transported patients in this category had higher survival than those in the ELSO registry). CONCLUSIONS: Interfacility transport on ECMO is feasible and can be accomplished safely in the critically ill. Survival of transported patients is comparable to age-matched and treatment-matched ECMO patients at large.
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