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Published on: October 24, 2018
[A multicenter retrospective study of secondary transport on extracorporeal membrane oxygenation in critically ill
1Pediatric Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100700, China.
Insights
Secondary extracorporeal membrane oxygenation (ECMO) transport for critically ill children is safe and effective. This transport does not increase mortality or severe complications, offering more treatment options for children needing advanced care.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Patient transport safety
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for critically ill children with cardiorespiratory failure.
- Secondary transport involves moving patients already on ECMO to another center for advanced care.
- Evaluating the safety and efficacy of secondary ECMO transport is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the safety and efficacy of secondary transport for pediatric patients on ECMO.
- To compare outcomes between primary and secondary ECMO transport groups.
- To identify factors influencing outcomes in pediatric ECMO transport.
Main Methods:
- Retrospective cohort study of 222 pediatric patients undergoing ECMO transport.
- Data collected from 5 ECMO centers and a national database (May 2019-May 2024).
- Comparison of clinical data, demographics, ECMO parameters, and complications between primary and secondary transport groups using statistical tests (t-test, Wilcoxon, chi-squared).
Main Results:
- Secondary transport patients were older, with higher rates of surgical cannulation, circulatory support, and pre-ECMO lactate levels.
- Higher vasoactive-inotropic scores and oxygenation index were observed in secondary transport patients requiring support.
- No significant differences in mortality or life-threatening complications were found between primary and secondary transport groups.
Conclusions:
- Secondary ECMO transport is a safe procedure for critically ill children, without increased mortality or severe complications.
- This transport modality offers crucial additional treatment opportunities for children unable to receive effective care locally.
- Transfer to advanced ECMO centers via secondary transport can improve access to specialized interventions like transplantation.
Abstract:
Objective: To evaluate the safety and efficacy of secondary transport on extracorporeal membrane oxygenation (ECMO) for critically ill children. Methods: This was a retrospective cohort study. Data from 222 pediatric patients who underwent ECMO transport from May 2019 to May 2024 at 5 ECMO centers and Chinese Database of Pediatric Extracorporeal Life Support Organization were collected. The cases were divided into primary and secondary transport groups by nature of transport. The clinical data, including demographics, ECMO indications, transport distance, pre-transport lab results, prognosis and complications were analyzed. Two independent samples t-test, Wilcoxon test, and χ2 test or Fisher's exact probability method were used to compare the differences between 2 groups and evaluate the safety and efficacy of secondary transport. Results: Among the 222 children transported with ECMO, there were 135 males and 87 females, with an age of 3.0 (0.2, 7.0) years. There were 202 cases in the primary transport group and 20 cases in the secondary transport group. All secondary transport patients had failed attempts at weaning ECMO before transfer. The patients in the secondary transport group were older, had higher rates of surgical cannulation, circulatory support, and pre-ECMO lactate levels compared to the primary transport group (7.0 (2.8, 10.0) vs. 3.0 (0.2, 6.0) years old, 55.0% (11/20) vs. 3.6% (7/202), 80.0% (16/20) vs. 41.6% (84/202), (10±4) vs. (7±6) mmol/L, Z=3.41, χ=66.31, 10.99, t=2.24, all P<0.05). In the secondary transport group, the vasoactive-inotropic scores of patients on circulatory support and the oxygenation index for patients requiring respiratory support were higher than those in the primary transport group (83±33 vs. 82±68, 51.0±1.8 vs. 37.4±10.2, t=2.36, 2.63, respectively; both P<0.05). There were no statistically significant differences between the 2 groups in sex, transport distance, pre-ECMO creatinine, arterial blood gas BE values, and ECMO duration (all P>0.05). No life-threatening complications occurred during the transport in either group. Two patients in the secondary transport group underwent heart transplantation, and 1 patient underwent radiofrequency ablation. The overall survival rate between the 2 groups showed no statistically significant difference (45.0% (9/20) vs. 55.4% (112/202), χ2=1.15, P>0.05). Conclusions: Secondary ECMO transport for critically ill children don't increase mortality or life-threatening complications during transport. ECMO patients who cannot receive effective treatment locally can benefit from secondary transport to an advanced ECMO center provides further treatment opportunities.
