Extracorporeal membrane oxygenation as a means of stabilizing and transporting high risk neonates

Term or near term newborns whose severity of cardiac or respiratory failure makes them candidates for extracorporeal membrane oxygenation (ECMO) are often too unstable to be safely transported to an ECMO-competent center. Faced with a large military and civilian referral population that is distributed across the entire continental United States, the authors have addressed this dilemma by developing a transportable ECMO system that can be taken to the referring hospital in a small transport aircraft. This system was on hand, but was not required, to stabilize and transport the infant in question in four cases. All had uneventful transports. Thirteen infants were placed on ECMO at their referring hospitals, one of whom died shortly after the institution of bypass. The remaining 12 infants were stabilized and transported successfully on ECMO over distances ranging from 17 to 1,437 miles, with 11 of these being long distance air transports. Four patients are long-term survivors. The authors conclude that a properly configured and managed ECMO system can effectively stabilize and transport even extremely ill neonates if the pertinent physiologic and aeromedical considerations are addressed.