Transport of critically ill patients in need of extracorporeal life support

In the past 10 years, we have seen tremendous growth in the use of ECMO for neonatal cardiopulmonary failure, and new indications are being recognized for the use of ECMO and other forms of ECLS in older children and adults. The number of medical centers providing ECLS is and will always be limited, so services are needed to transport critically ill patients to ECLS centers. Transport teams should be thoroughly familiar with the pathophysiology of cardiac and respiratory failure. They should be equipped to continue the monitoring and treatment initiated at the referring center, to maintain that level of care during transfer, and to treat complications of the diseases or of the therapy itself. The responsibilities of the referring centers are to acquaint themselves with ECLS programs in their geographic areas and with transport services available. Early communication with complete and accurate information is essential. Developing a program for ECLS during transport is a huge undertaking that should be considered seriously. Not every ECLS center has the resources to embark on such a program. Timely referral should make such complex transfers unnecessary for most patients.