The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

CASE SERIES REPORT OF A RAPID DELOYMENT LOW RESOURCE MODEL FOR PEDIATRIC EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) TRANSPORT.

Bradley Kuch1, Tim M. Maul2,3, Erin L. Wacker2,3, Victor O. Morell1, Peter D. Wearden1,3; 1Cardiothoracic Surgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; 2Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; 3McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA

Background Children with severe heart failure are often stabilized with ECMO until a definitive diagnosis is made or function recovers. In some cases, cardiac function does not improve requiring bridge to transplantation using a ventricular assist device (VAD). Access to centers specializing in long term mechanical support and transplantation, may require transport while on ECMO. We sought to describe our experience with ECMO transport in children requiring VAD support as a bridge to cardiac transplantation using a rapidly deployed, low resource transport model. METHODS Retrospective review of 6 patients transported on ECMO for VAD as bridge to transplantation. Descriptive statistics were used to evaluate demographic, transport, ECMO, and complication data. Outcome, intensive care unit, and hospital length of stay data were also evaluated. Complications were defined as loss of oxygen supply, pump failure, hypothermia (< 34∞C), and hypoxia (SpO2 < 90%). All patients were supported during transport with a centrifugal pump and the transport team consisted of a registered nurse, respiratory therapist, perfusionist, and a transport physician. RESULTS Six pediatric patients were transported on ECMO for VAD referral from March 2008 to January 2010. Demographic and transport variables are illustrated in Table 1. Three (50%) subjects were transferred for cardiomyopathy, 2 (33%) for heart failure, and 1 (17%) for a left ventricular mass. Three patients (50%) were transported by fixed wing aircraft, 2 (33%) by ambulance (20%) and 1 (17%) by helicopter. The overall complication rate was 33% (2) with both events being hypoxia requiring minimal intervention. Duration of ECMO support at the receiving facility was 95.0±33.8 (240-32) hours with 4 (67%) patients being placed on VADs from ECMO and 2 (33%) patients recovering without VAD support. Length of ICU stay was 27.4±4.7 (45-19) and duration of hospital stay was 32.6±4.6 (45-22). No complications occurred precluding these patients from transplantation. CONCLUSIONS In this small case series, we describe our experience with ECMO transport using a rapidly deployed low resource model. Given the relatively quick response time, rate of low severity complications, and excellent outcomes, we feel our model of ECMO transport can be accomplished safely in children on ECMO to centers specializing in VAD support or transplantation. Additional study is needed to evaluate the rate of complications and outcome in a larger data set. Sponsored Research - None Demographic and Transport Variables