Patient Safety during ECMO Transportation: Single Center Experience and Literature Review

Mateusz Puslecki; Konrad Baumgart; Marcin Ligowski; Marek Dabrowski; Sebastian Stefaniak; Malgorzata Ladzinska; Ewa Goszczynska; Pawel Marcinkowski; Anna Olasinska-Wisniewska; Tomasz Klosiewicz; Aleksander Pawlak; Marcin Zielinski; Lukasz Puslecki; Roland Podlewski; Lukasz Szarpak; Marek Jemielity; Bartlomiej Perek

doi:10.1155/2021/6633208

Patient Safety during ECMO Transportation: Single Center Experience and Literature Review

Emerg Med Int. 2021 Feb 22:2021:6633208. doi: 10.1155/2021/6633208. eCollection 2021.

Authors

Mateusz Puslecki^{1

2

3}, Konrad Baumgart², Marcin Ligowski², Marek Dabrowski^{3

4}, Sebastian Stefaniak², Malgorzata Ladzinska², Ewa Goszczynska², Pawel Marcinkowski², Anna Olasinska-Wisniewska², Tomasz Klosiewicz¹, Aleksander Pawlak⁵, Marcin Zielinski^{1

5}, Lukasz Puslecki⁶, Roland Podlewski¹, Lukasz Szarpak^{3

7}, Marek Jemielity², Bartlomiej Perek²

Affiliations

¹ Department of Medical Rescue, Poznan University of Medical Sciences, Collegium Adama Wrzoska Rokietnicka Street 7, Poznan 60-806, Poland.
² Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Dluga Street 1/2, Poznan 61-848, Poland.
³ Polish Society of Medical Simulation, Slupca, Poland.
⁴ Department of Medical Education, Poznan University of Medical Sciences, Collegium Adama Wrzoska Rokietnicka Street 7, Poznan 60-806, Poland.
⁵ Voivodeship Emergency Station, Poznan, Poland.
⁶ Department of International Management, Poznan University of Economics and Business, 10 Niepodleglosci Av., Poznan 61-875, Poland.
⁷ Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., Warsaw 03-411, Poland.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams.

Aim: The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature.

Methods: A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019.

Results: Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2-63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5-200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%).

Conclusions: Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety.