Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience
Background: Extracorporeal membrane oxygenation (ECMO) has been proven to be a support method and technology for patients with cardiopulmonary failure. However, the transport of patients under ECMO support is challenging given the high-risk technical maneuvers and patient-care concerns involved. Her...
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2025-01-01
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| Series: | Journal of Intensive Medicine |
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| author | Lingjuan Liu Dingji Hu Tong Hao Shanshan Chen Lei Chen Yike Zhu Chenhui Jin Jing Wu Haoya Fu Haibo Qiu Yi Yang Songqiao Liu |
| author_facet | Lingjuan Liu Dingji Hu Tong Hao Shanshan Chen Lei Chen Yike Zhu Chenhui Jin Jing Wu Haoya Fu Haibo Qiu Yi Yang Songqiao Liu |
| author_sort | Lingjuan Liu |
| collection | DOAJ |
| description | Background: Extracorporeal membrane oxygenation (ECMO) has been proven to be a support method and technology for patients with cardiopulmonary failure. However, the transport of patients under ECMO support is challenging given the high-risk technical maneuvers and patient-care concerns involved. Herein, we examined the safety of ECMO during the transport of critically ill patients and its impact on mortality rates, to provide more secure and effective transport strategies in clinical practice. Method: To assess the safety of ECMO patient transport, this study conducted a retrospective analysis on critically ill adults who required ECMO support and transport at the intensive care unit (ICU) center between 2017 and 2023. The study utilized standard ECMO transport protocols and conducted a comprehensive statistical analysis of the collected clinical data and transport processes. The 28-day survival rate for ECMO patients was determined using Kaplan–Meier analysis, while logistic regression identified prognostic factors. Result: Out of 303 patients supported with ECMO, 111 (36.6%) were transported. 69.4% of the transport group were male, mean age was (42.0±17.0) years, mean body mass index was (24.4±4.6) kg/m2, and veno-arterial-ECMO accounted for 52.5%. The median transportation distance was 190 (interquartile range [IQR]: 70–260) km, and the longest distance was 8100 km. The median transit time was 180 (IQR: 100–260) min, and the maximum duration was 1720 min. No severe adverse events including death or mechanical failure occurred during transportation. The 28-day survival rate was 64.7% (n=196) and ICU survival rate was 56.1% (n=170) for the entire cohort; whereas, the 28-day survival rate was 72.1% (n=80) and ICU survival rate was 66.7% (n=74) in the transport group. A non-significant difference in 28-day survival was observed between the two groups after propensity score matching (P=0.56). Additionally, we found that acute physiology and chronic health evaluation II score (odds ratio [OR]=1.06, P <0.01), lactate levels (>5 mmol/L, OR=2.80, P=0.01), and renal replacement therapy initiation (OR=3.03, P <0.01) were associated with increased mortality risk. Conclusion: Transporting patients on ECMO between medical facilities is a safe procedure that does not increase patient mortality rates, provided it is orchestrated and executed by proficient transport teams. The prognostic outcome for these patients is predominantly influenced by their pre-existing medical conditions or by complications that may develop during the course of ECMO therapy. These results form the basis for the creation of specialized ECMO network hubs within healthcare regions. |
| format | Article |
| id | doaj-art-f97e86e498a54d33a9771eaf9bee8748 |
| institution | Kabale University |
| issn | 2667-100X |
| language | English |
| publishDate | 2025-01-01 |
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| series | Journal of Intensive Medicine |
| spelling | doaj-art-f97e86e498a54d33a9771eaf9bee87482025-01-05T04:28:45ZengElsevierJournal of Intensive Medicine2667-100X2025-01-01513542Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experienceLingjuan Liu0Dingji Hu1Tong Hao2Shanshan Chen3Lei Chen4Yike Zhu5Chenhui Jin6Jing Wu7Haoya Fu8Haibo Qiu9Yi Yang10Songqiao Liu11Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, ChinaDepartment of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China; Department of Critical Care Medicine, Trauma Center, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, Jiangsu, China; Corresponding author: Songqiao Liu, Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 211200, Jiangsu, China.Background: Extracorporeal membrane oxygenation (ECMO) has been proven to be a support method and technology for patients with cardiopulmonary failure. However, the transport of patients under ECMO support is challenging given the high-risk technical maneuvers and patient-care concerns involved. Herein, we examined the safety of ECMO during the transport of critically ill patients and its impact on mortality rates, to provide more secure and effective transport strategies in clinical practice. Method: To assess the safety of ECMO patient transport, this study conducted a retrospective analysis on critically ill adults who required ECMO support and transport at the intensive care unit (ICU) center between 2017 and 2023. The study utilized standard ECMO transport protocols and conducted a comprehensive statistical analysis of the collected clinical data and transport processes. The 28-day survival rate for ECMO patients was determined using Kaplan–Meier analysis, while logistic regression identified prognostic factors. Result: Out of 303 patients supported with ECMO, 111 (36.6%) were transported. 69.4% of the transport group were male, mean age was (42.0±17.0) years, mean body mass index was (24.4±4.6) kg/m2, and veno-arterial-ECMO accounted for 52.5%. The median transportation distance was 190 (interquartile range [IQR]: 70–260) km, and the longest distance was 8100 km. The median transit time was 180 (IQR: 100–260) min, and the maximum duration was 1720 min. No severe adverse events including death or mechanical failure occurred during transportation. The 28-day survival rate was 64.7% (n=196) and ICU survival rate was 56.1% (n=170) for the entire cohort; whereas, the 28-day survival rate was 72.1% (n=80) and ICU survival rate was 66.7% (n=74) in the transport group. A non-significant difference in 28-day survival was observed between the two groups after propensity score matching (P=0.56). Additionally, we found that acute physiology and chronic health evaluation II score (odds ratio [OR]=1.06, P <0.01), lactate levels (>5 mmol/L, OR=2.80, P=0.01), and renal replacement therapy initiation (OR=3.03, P <0.01) were associated with increased mortality risk. Conclusion: Transporting patients on ECMO between medical facilities is a safe procedure that does not increase patient mortality rates, provided it is orchestrated and executed by proficient transport teams. The prognostic outcome for these patients is predominantly influenced by their pre-existing medical conditions or by complications that may develop during the course of ECMO therapy. These results form the basis for the creation of specialized ECMO network hubs within healthcare regions.http://www.sciencedirect.com/science/article/pii/S2667100X24000653Extracorporeal membrane oxygenationTransportationPrognosis |
| spellingShingle | Lingjuan Liu Dingji Hu Tong Hao Shanshan Chen Lei Chen Yike Zhu Chenhui Jin Jing Wu Haoya Fu Haibo Qiu Yi Yang Songqiao Liu Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience Journal of Intensive Medicine Extracorporeal membrane oxygenation Transportation Prognosis |
| title | Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience |
| title_full | Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience |
| title_fullStr | Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience |
| title_full_unstemmed | Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience |
| title_short | Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience |
| title_sort | outcomes and risk factors of transported patients with extracorporeal membrane oxygenation an ecmo center experience |
| topic | Extracorporeal membrane oxygenation Transportation Prognosis |
| url | http://www.sciencedirect.com/science/article/pii/S2667100X24000653 |
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