Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation.

Abstract

Extracorporeal membrane oxygenation (ECMO) support is indicated for patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. The practitioner’s experience and quantity of necessary resources are reasons why regionalization could benefit these types of patients, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and interterritorial approach. ECMO transportation is safer than without mechanical support, although there are currently no criteria for starting the therapy on patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of the transfer can improve results. There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes, data that could help with the indication and management of this type of transportation.