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abstract
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BACKGROUND
Patients undergoing extracorporeal membrane oxygenation (ECMO) are
critically ill and show high mortality. Inter-hospital transfer of
these patients has to be safe, with high survival rates during
transport without potentially serious and life-threatening adverse
events. The Swiss Air-Rescue provides 24-h/7-days per week
inter-hospital helicopter transfers that include on-site ECMO
cannulation if needed. This retrospective observational study
describes adverse events of patients on ECMO transported by
helicopter, and their associated survival.
METHODS
All patients on ECMO with inter-hospital transfer by helicopter from
start of service in February 2009 until May 2021 were included.
Patients not transported by helicopter or with missing medical
records were excluded. Patient demographics (age, sex) and medical
history (type of and reason for ECMO), mission details (flight
distance, times, primary or secondary transport), adverse events
during the inter-hospital transfer, and survival of transferred
patients were recorded. The primary endpoint was patient survival
during transfer. Secondary endpoints were adverse events during
transfer and 28-day survival.
RESULTS
We screened 214 ECMO-related missions and included 191 in this
analysis. Median age was 54.6 [IQR 46.1-62.0] years, 70.7% were
male, and most patients had veno-arterial ECMO (56.5%). The main
reasons for ECMO were pulmonary (46.1%) or cardiac (44.0%) failure.
Most were daytime (69.8%) and primary missions
(n = 100), median total mission time was 182.0
[143.0-254.0] min, and median transfer distance was 52.7 [33.2-71.1]
km. All patients survived the transfer. Forty-four adverse events
were recorded during 37 missions (19.4%), where 31 (70.5%) were
medical and none resulted in patient harm. Adverse events occurred
more frequently during night-time missions (59.9%,
p = 0.047). Data for 28-day survival were available
for 157 patients, of which 86 (54.8%) were alive.
CONCLUSION
All patients under ECMO survived the helicopter transport. Adverse
events were observed for about 20% of the flight missions, with a
tendency during the night-time flights, none harmed the patients.
Inter-hospital transfer for patients undergoing ECMO provided by
24-h/7-d per week helicopter emergency medical service teams can be
considered as feasible and safe. The majority of the patients
(54.8%) were still alive after 28 days.
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citation
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Fuchs A, Schmucki R, Meuli L, Wendel-Garcia P D, Albrecht R, Greif
R, Pietsch U. Helicopter inter-hospital transfer for patients
undergoing extracorporeal membrane oxygenation: a retrospective
12-year analysis of a service system. Scand J Trauma Resusc Emerg
Med 2022; 30:33.
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