ECMO is in the air: Long distance air/ground transport of a child on extra corporeal membrane oxygenation

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical support system that handles the function of the heart and/or lungs in patients with a variety of cardiac and respiratory problems. Veno-arterial ECMO is most commonly used for patients recovering from heart surgery, suffering from cardiac shock, or awaiting a heart transplant. Case report: A 7 year old boy with a single ventricle physiology was admitted for a Fontan procedure with repair of the common valve. At the end of surgery, transesophagal echocardiography showed a severely depressed myocardial function, and weaning of bypass required a high inotropic support. During the following week, the heart never recovered, with an ejection fraction at 24%. Veno-Arterial ECMO was decided on postoperative day 9 with a 19 Fr venous cannula inserted through the right jugular vein into the intracardiac Fontan baffle, and a 15 Fr arterial cannula into the right carotid artery.On ECMO day 7, after failure to wean from ECMO, he was listed for an urgent heart transplant, with the suggestion of a transfer to Europe, for a shorter transplantation delay.The ECMO team from Hamad Hospital in Qatar accomplished the transfer successfully, on a humanitarian basis. The transfer was done on ECMO Day 10. The child was safely admitted to a hospital in Belgium, and listed again for an urgent heart transplant. Conclusion: With an experienced team, and the proper equipment, on-ECMO air transport of critical patients over thousands of kilometers is today safely feasible. Keywords: ECMO, Medical air transport, Critical care, Levosimendan