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Critical Care |

Remote Cannulation and ECMO Transport Is Safe in a Newly Established Program

David Grenda, MD; Vanessa Moll, MD; james Blum, MD
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Emory University, Decatur, GA


Chest. 2015;148(4_MeetingAbstracts):291A. doi:10.1378/chest.2278860
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Abstract

SESSION TITLE: ECMO Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Starting September 1, 2014, Emory University Hospital launched a new ECMO Center. As Emory Healthcare consists of 4 hospitals, it was decided the center would provide remote ECMO cannulation and transport services from its first day of operation. We sought to determine if transport services can be safely provided by a new ECMO program.

METHODS: We reviewed the logs of the Emory ECMO Center from September 1, 2014 to February 28, 2015, identifying cases transported from remote hospitals. Notes from the individual cases and comments from the providers involved were reviewed by the authors for the first 6 months of the service.

RESULTS: From September 1, 2014 to February 28, 2015, 9 patients were transferred from outside hospitals on ECMO support. 7 patients were transferred by ground, 2 by fixed wing. 8 patients were accompanied by the Emory ECMO Transport Service consisting of 1-2 physicians, a perfusionist, and a specially trained EMT or nurse. 5 patients were cannulated remotely by the Emory ECMO Transport Service. 3 patients were cannulated by outside physicians and transferred by the Emory ECMO Transport Service. 1 Patient was cannulated and transferred by physicians at the outside hospital. There were no ECMO complications during transport. There were a total of 4 mechanical failures during transport of other systems. Failures included damaged tires, vehicle battery malfunction, ventilator failure, and under-filled oxygen tanks. Failures resulted in a delay of transport, but none resulted in subsequent morbidity or mortality. In total, 2 of 3 patients requiring VV ECMO and 3 of 6 patients requiring VA ECMO at the time of transfer survived to hospital discharge. Thus, patients transferred had similar survival to patients cannulated at Emory University Hospital (P=0.6).

CONCLUSIONS: A new ECMO program can safely provide transport and remote cannulation services. Patients that are transported from outside hospitals have similar survival to those that are started on therapy at the local institution. Technical complications related to the ECMO circuit and cannulation are rare, but complications of other necessary transport systems is common.

CLINICAL IMPLICATIONS: New ECMO programs can expect a significant volume of outside hospital transport requests. Technical complications of ancillary equipment, but not the primary ECMO circuit are most common. Hence, it is necessary to prepare for delays in transport, but these delays are not typically catastrophic and can be managed by a physician directed transport team.

DISCLOSURE: The following authors have nothing to disclose: David Grenda, Vanessa Moll, james Blum

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