Outcomes of Urgent Interhospital Transportation for Extracorporeal Membrane Oxygenation Patients

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) can be used in patients with refractory cardiogenic shock or respiratory failure. In South Korea, the need for transporting ECMO patients is increasing. Nonetheless, information on urgent transportation and its outcomes is scant. Methods: In this retrospective review of 5 years of experience in ECMO transportation at a single center, the clinical outcomes of transported patients were compared with those of in-hospital patients. The effects of transportation and the relationship between insertion– departure time and survival were also analyzed. Results: There were 323 cases of in-hospital ECMO (in-hospital group) and 29 cases transferred to Hallym University Sacred Heart Hospital without adverse events (mobile group). The median transportation time was 95 minutes (interquartile range [IQR], 36.5–119.5 minutes), whereas the median transportation distance was 115 km (IQR, 15–115 km). Transportation itself was not an independent risk factor for 28-day mortality (odds ratio [OR], 0.818; IQR, 0.381–1.755; p=0.605), long-term mortality (OR, 1.099; IQR, 0.680–1.777; p=0.700), and failure of ECMO weaning (OR, 1.003; IQR, 0.467–2.152; p=0.995) or survival to discharge (OR, 0.732; IQR, 0.337–1.586; p=0.429). After adjustment for covariates, no significant difference in the ECMO insertion–departure time was found between the survival and mortality groups (p=0.435). Conclusion: The outcomes of urgent transportation, with active involvement of the ECMO center before ECMO insertion and adherence to the transport protocol, were comparable to those of in-hospital ECMO patients.

Keywords

• extracorporeal membrane oxygenation
• patient transfer
• cardiogenic shock
• respiratory insufficiency