Interhospital Extracorporeal Membrane Oxygenation Transport Status Need and Safety in Pre- and Post-COVID-19 Era: An Indian Experience

Aims and background: Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving modality for patients with severe reversible pulmonary and/or cardiac failure.However, its use is currently restricted to a few highly equipped referral centers.Conventional transports to an ECMO center may pose significant risks.The optimal outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams.This study aims to evaluate the status and safety of ECMO transport in the Indian scenario and explore trend changes in ECMO transport between the pre-and post-COVID eras.Materials and methods: This retrospective, observational study depicts the data from six ECMO centers over the last decade, during which 209 patients were evaluated.The analysis includes an assessment of transport arrangements, various characteristics of ECMO retrieval patients, their outcomes, mortality rate, and complications.Results: Patients with an average age of approximately 47 years were included in the study.The average ECMO retrieval time was 199.3 minutes.The majority of the patients (92.82%) underwent venovenous (VV) type of ECMO support.One death was reported during ECMO transport in the post-COVID era.No major complications were reported.The most common complications observed were flow problems (20 cases), followed by pneumothorax (four cases) and power failure (three cases), which were minor.Extracorporeal membrane oxygenation transport facilities have significantly improved from the pre-COVID-19 to post-COVID-19 era, in terms of the increased number of ECMO centers and patients transferred via road and air modes.Conclusion: Based on our findings, patient transfer is safe when executed with proper protocols by a well-prepared team that has a comprehensive understanding of potential challenges.This is especially true for patients on ECMO support who are being transferred to a referral institution.Our study showed that there was no significant increase in the risk of mortality for ECMO patients undergoing transfer, provided that the transfer is done correctly.Our experience in India suggests that despite challenges associated with ECMO transport during the COVID-19 pandemic, there has been an overall improvement in ECMO transport facilities post-COVID-19 compared to the pre-COVID-19 era.Clinical significance: Transporting a patient on ECMO support is safe when executed with proper protocols by a well-prepared team.