Mobile ECMO for Long Distance Ground Transport in a Pediatric Cardiac Patient with Central VA-ECMO in Japan

Abstract

A 3-year-old, female patient required venous-arterial extracorporeal membrane oxygenation (VA-ECMO) for ischemic cardiomyopathy. Conversion from ECMO to a ventricular assist device was needed due to failure to wean from ECMO. The patient was therefore transported to another hospital 520 km away via ground transport. We used our own ambulance which was specially equipped for pediatric ECMO transportation. Estimation of the total electricity and oxygen consumption during transportation indicated that these were well within safety parameters. On the day prior to transport, the perfusion cannula site was moved from the ascending aorta to the right common carotid artery, and the depth of the drainage cannula was increased to minimize the risk of accidental dislodgement. The patient was secured, along with the medical equipment, onto a single backboard in the ambulance. The transport team was divided into two groups to monitor the patient in shifts. The patient was transported without any adverse events. Precautions should be taken to avoid potentially life-threatening but preventable events such as difficulties with medical equipment and accidental dislodgement of ECMO cannulas. Pediatric ECMO has a particularly high risk of accidental cannula dislodgement during transport due to vibrations and acceleration. It is important to prepare for these contingencies and to assemble a team capable of responding to them. Since there are few pediatric ECMO cases in Japan, more data is urgently needed to standardize the transport process.