1887
2 - Qatar Health 2021 Conference abstracts
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Transport and retrieval of patients on extracorporeal membrane oxygenation (ECMO) support can be hazardous with complications reported for up to 27% of patients1. Transport of COVID-19 patients on ECMO requires appropriate training, resource allocation, meticulous planning, effective communication and co-ordination. Strict adherence to infection control procedures and appropriate use of personal protective equipment is recommended2. The Extracorporeal Life Support Organisation registry reports 43% in-hospital mortality of COVID-19 patients supported on ECMO. This includes in-house and retrieval ECMO cases3. Between March 1st and September 30th 2020, 32 confirmed COVID-19 positive patients underwent peripheral cannulation followed by transportation to the Medical Intensive Care Unit (MICU) at Hamad General Hospital. Mobile ECMO is complex and time consuming. Following arrival at the bedside and thorough clinical assessment, the ECMO consultant may decline, recommend optimisation of the care provided, or opt for cannulation and initiation of ECMO. Cannulation can be performed at the bedside or in the operating room. Following stabilisation, the patient is transferred for computed tomography imaging and then transported by ambulance to hospital (Figure 1). Finally, another transfer from hospital entrance to the MICU takes place. All these phases pose risks for errors and complications unless vigilance, teamwork and continuous effective monitoring and co-ordination is observed. Patients were evaluated for age and severity of illness (Table 1). In addition, all major transport-related adverse events were reported and analysed. Major transport events are cardiac arrest, ECMO emergencies (membrane or mechanical failure, air embolism, accidental decannulation, or significant cannula dislodgement), significant arrhythmia, severe bleeding or cardio-respiratory instability, and vehicle breakdown/malfunction. The majority of our patients were critically ill with high probability of mortality as depicted by SOFA and APACHE2 score. 29 out of 32 patients were male. None of our patients suffered major complications during transportation. This small case series demonstrates transport and retrieval on ECMO for COVID-19 positive patients can be safely undertaken provided appropriate expertise, protocols and resources are used.

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/content/journals/10.5339/jemtac.2021.qhc.13
2021-09-07
2021-09-27
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References

  1. Broman LM, Holzgraefe B, Palmer K, Frencker B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care. 2015; 19:(1):278.
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  2. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020; 8:(5):518–526.
    [Google Scholar]
  3. Extracorporeal Life Support Organization COVID-19 Interim Guidelines. A consensus document from an international group of interdisciplinary ECMO providers. [Internet]. (Accessed 1/11/2020). Available from: https://www.elso.org/Portals/0/Files/pdf/ELSO%20covid%20guidelines%20final.pdf..
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  • Article Type: Conference Abstract
Keyword(s): complications , COVID-19 , ECMO , safety and transport and retrieval
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