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ECMO Transport without Physicians or Additional Clinicians

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  30 October 2020

Anna Condella ,
Jeremy B. Richards ,
Michael A. Frakes ,
Christian J. Grant ,
Jason E. Cohen  and
Susan R. Wilcox Open the ORCID record for Susan R. Wilcox [Opens in a new window]
Anna Condella
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsUSA
Jeremy B. Richards
Affiliation:
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Michael A. Frakes
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Christian J. Grant
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Jason E. Cohen
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Department of Surgery, Brigham and Women’s Hospital, Boston, MassachusettsUSA
Susan R. Wilcox*
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsUSA Boston MedFlight, Bedford, MassachusettsUSA
*
Correspondence: Susan R. Wilcox, MD, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts02114USA, E-mail: swilcox1@partners.org
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Abstract

Background:

Extracorporeal membrane oxygenation (ECMO) has accelerated rapidly for patients in severe cardiac or respiratory failure. As a result, ECMO networks are being developed across the world using a “hub and spoke” model. Current guidelines call for all patients transported on ECMO to be accompanied by a physician during transport. However, as ECMO centers and networks grow, the increasing number of transports will be limited by this mandate.

Objectives:

The aim of this study was to compare rates of adverse events occurring during transport of ECMO patients with and without an additional clinician, defined as a physician, nurse practitioner (NP), or physician assistant (PA).

Methods:

This is a retrospective cohort study of all adults transported while cannulated on ECMO from 2011-2018 via ground and air between 21 hospitals in the northeastern United States, comparing transports with and without additional clinicians. The primary outcome was the rate of major adverse events, and the secondary outcome was minor adverse events.

Results:

Over the seven-year study period, 93 patients on ECMO were transported. Twenty-three transports (24.7%) were accompanied by a physician or other additional clinician. Major adverse events occurred in 21.5% of all transports. There was no difference in the total rate of major adverse events between accompanied and unaccompanied transports (P = .91). Multivariate analysis did not demonstrate any parameter as being predictive of major adverse events.

Conclusions:

In a retrospective cohort study of transports of ECMO patients, there was no association between the overall rate of major adverse events in transport and the accompaniment of an additional clinician. No variables were associated with major adverse events in either cohort.

Keywords

adverse eventsextracorporeal membrane oxygenationresource allocationtransportation of patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 51 - 57
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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