Pediatric Extracorporeal Life Support Transport in Western Canada: Experience over 14 years

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary support technologies

Background:

• Extracorporeal life support (ECLS) is a vital intervention for critically ill children with organ failure.
• Pediatric ECLS transport requires specialized teams and protocols to manage complex cases during transit.
• Outcomes and safety of interfacility ECLS transports, particularly concerning cannulation strategies, require further investigation.

Purpose of the Study:

• To evaluate the safety and outcomes of pediatric ECLS transports conducted by a specialized transport team.
• To compare outcomes between primary transports (cannulation by the transport team) and secondary transports (cannulation by the referring facility).
• To assess the impact of referring centers having an established ECLS cannulation program on transport outcomes.

Main Methods:

• Retrospective cohort study of pediatric patients transported on ECLS between 2004 and 2018.
• Comparison of outcomes and complications between primary and secondary ECLS transports.
• Analysis of secondary transports based on whether the referring facility had an ECLS cannulation program.
• Data collection included transport characteristics, cannulation strategy, complications, and survival to ECLS decannulation.

Main Results:

• A total of 68 ECLS transports were analyzed, with a median transport distance of 298 km.
• Mean time from referral call to ECLS initiation was significantly shorter for secondary transports (2.5 hours) compared to primary transports (7.8 hours).
• Complications were frequent (95%) but rarely led to adverse outcomes, with no significant difference between primary and secondary transports.
• Survival to ECLS decannulation showed no significant difference between primary (90%) and secondary (74%) transports.
• Survival was higher for children cannulated by the specialized team or at a center with an ECLS program (82%) versus those cannulated at centers without such a program (59%).

Conclusions:

• Specialized pediatric ECLS transport teams can safely manage critically ill children requiring extracorporeal support during interfacility transfers.
• Secondary transports from referring centers with established ECLS cannulation programs are safe and yield comparable outcomes to primary transports.
• The cannulation strategy at the referring facility significantly impacts ECLS survival, highlighting the importance of experienced ECLS programs at referring institutions.