ECLS Supported Transport of Intensive Care Unit Patients—Is It Worth the Effort?

Background: Extracorporeal life support (ECLS) is an established tool to stabilize patients with therapy-refractory severe hemodynamic or respiratory failure. We have established a mobile ECMO retrieval service over the recent years at our institution. However, data on the outcome of patients receiving ECLS for transportation into tertiary hospitals is still sparse.

Methods: We have evaluated all our patients receiving ECLS in other hospitals prior to transportation in our institute.

Results: Between 2012 and 2017, we have performed 205 ECLS transport by our mobile ECLS team, with increasing numbers (2012: n = 23, 2013 n = 35, 2014 n = 29, 2015 n = 38, 2016 n = 47, 2017 n = 37). Average age of patients was 48 years with no significant differences over the years (range: 1 day–71 years). A total of 137 of patients (67%) were male. Indication for ECLS support was: respiratory failure 59%, primary cardiac failure 32%, primary pulmonary hypertension 2%, lung embolism 4%, congenital diaphragmatic hernia 1%, and unknown reasons 2%. ECLS duration was 7.5 days (± 6 days). Overall survival rate was 60.5%, increasing from 39% in 2012 to 66.7 in 2017 (p = n.s.). Survival rates were dependent per treatment with the best survival for veno-venous Support. Venoarterial ECLS patients tended to show worse outcomes, most likely to the acute severity of their underlying disease and the need for a more urgent ECLS implantation.

Conclusion: Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 hours/7 days ECLS standby for secondary and primary hospitals as a tertiary clinic. Increasing indications and total numbers for ECLS support raises the need for further studies to evaluate outcome in these patients.

 

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No conflict of interest has been declared by the author(s).