Our approach for out-of-center initiation of extracorporeal membrane oxygenation and subsequent interhospital transport

Extracorporeal membrane oxygenation (ECMO) initiation at a non-ECMO-capable facility by specialized mobile teams aims for a stabilization prior to center admission, internationally referred to as ECMO retrieval. It is a recommended strategy to avoid primary interhospital transfer of compromised patients with a high risk of life-threatening incidents and potentially death. Deploying the unique skill set of ECMO installation and transportation to an unfamiliar environment, however, adds a further degree of complexity to the demanding fields of both transporting the critically ill and ECMO management itself. Although recommendations for the initiation of ECMO retrieval programs exist, centers globally tailor their course of action to local individual needs and so do we.The purpose of this work is to portray the decision-tree-based protocol of the intensive care unit 13i2 (Department of Medicine I, Medical University of Vienna) with its operational standards for optimal patient selection and transport organization.