Related Experiment Videos
A 16-year neonatal/pediatric extracorporeal membrane oxygenation transport experience
Bernard J Wilson1, Howard S Heiman, Thomas J Butler
1Department of Pediatrics, Section of Newborn Medicine, San Antonio Military Pediatric Center, San Antonio, Texas, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) transport shows acceptable survival but carries risks. Early referral to an ECMO center is recommended over transport, especially for meconium aspiration syndrome cases.
Area of Science:
- Pediatric critical care medicine
- Neonatal intensive care
- Cardiothoracic surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) provides life support for critically ill neonates and children.
- ECMO transport involves specialized teams moving patients on life support.
- Wilford Hall Medical Center (WHMC) has experience in ECMO patient transport since 1985.
Purpose of the Study:
- To characterize the population and survival rates of neonatal and pediatric patients transported on ECMO by WHMC.
- To compare outcomes for meconium aspiration syndrome (MAS) neonates treated in-house versus those transported on ECMO.
Main Methods:
- Retrospective review of patient charts, literature, and databases for ECMO transports by WHMC.
- Subpopulation analysis comparing in-house MAS ECMO patients with transported MAS ECMO patients.
- Evaluation of disease severity, age at ECMO initiation, survival, complications, and duration of support.
Main Results:
- Forty-two ECMO transports were identified across neonatal respiratory, pediatric respiratory, and cardiac cases.
- Overall survival rates varied by condition, with neonatal respiratory cases at 57% and pediatric respiratory at 71%.
- Neonates with MAS had significantly higher survival when treated in-house (97%) compared to those transported on ECMO (75%).
Conclusions:
- ECMO transport is associated with acceptable survival rates but remains a high-risk procedure.
- Early referral to an established ECMO center is preferable to ECMO transport.
- No ECMO-related complications directly causing death were identified in the transport group.
Objective:
To characterize the population and survival of neonatal and pediatric patients transported by Wilford Hall Medical Center (WHMC) on extracorporeal membrane oxygenation (ECMO) since 1985.
Study Design:
A retrospective chart, literature, and database review of pediatric and neonatal patients transported on ECMO by the WHMC ECMO transport team. In addition, a subpopulation analysis was performed comparing neonates with meconium aspiration syndrome (MAS) placed on ECMO at WHMC with those infants with MAS transported on ECMO. Characteristics of interest for this comparison included disease severity before ECMO, age at initiation of ECMO, survival, ECMO-related complications, and duration of ECMO support.
Results:
Forty-two patients transported on ECMO were identified: 23 neonatal respiratory cases (survival 57%), 7 pediatric respiratory cases (survival 71%), 4 cardiac cases (survival 50%), and 8 extra-institutional ECMO transports (survival 63%). In the MAS subpopulation, there was significantly greater survival in the in-house group--97% (31/32)--than in the ECMO transport group--75% (9/12); there were no other significant differences between these groups. Overall, no ECMO-related complications leading to patient demise could be identified in the ECMO transport group.
Conclusions:
ECMO transport, although demonstrating acceptable survival, is a risk-laden modality that should not replace early referral to an ECMO center.