Challenges and implementation of extracorporeal membrane oxygenation transport program in a low-resource setting

Area of Science:

• Critical Care Medicine
• Cardiovascular Surgery
• Cardiopulmonary Bypass

Background:

• Extracorporeal membrane oxygenation (ECMO) transport is standard in high-resource areas but limited in low- and middle-income countries (LMICs).
• Financial, infrastructural, and staffing constraints hinder ECMO transport in LMICs.
• This study assesses ECMO transport safety and outcomes in a low-resource setting.

Purpose of the Study:

• To evaluate the safety, complications, and clinical outcomes of inter-hospital ECMO transport.
• To compare outcomes between COVID-19 and non-COVID-19 patients undergoing ECMO transport.
• To determine the feasibility of ECMO transport in a low-resource environment.

Main Methods:

• Retrospective analysis of 39 patients undergoing ECMO transport from January 2019 to January 2023.
• Data collected included demographics, transport logistics, ECMO configuration, complications, and survival.
• Subgroup analysis compared outcomes for COVID-19 and non-COVID-19 patients.

Main Results:

• All 39 patients survived transport; one experienced a mechanical complication (2.6%).
• Common complications included infection (53.8%), major bleeding (23.1%), and pneumothorax (5.1%).
• Overall survival to discharge was 69.2%, with significantly lower survival for COVID-19 patients (42.9% vs. 81.8%).

Conclusions:

• ECMO transport is safely implementable in low-resource settings.
• Outcomes achieved are comparable to in-house ECMO support.
• Standardized protocols and expanded ECMO networks are crucial for improving outcomes in resource-limited areas.