500 Kilometers on ECMO: A Landmark Pediatric Transport across Central India

BackgroundThis presentation highlights a 500 kilometer road extracorporeal membrane oxygenation (ECMO) transport, detailing the clinical, logistical, and operational challenges encountered during the inter-hospital transfer of a critically ill pediatric patient.The case involved a 7-year-old boy from Nagpur suffering from severe respiratory distress, refractory hypoxemia, and complications such as pneumothorax and pneumomediastinum.Despite being on mechanical ventilation, his condition continued to deteriorate, necessitating urgent VV ECMO support and transfer to a tertiary center over 500 kilometers away. MethodsThe transport operation required meticulous planning and rapid decision-making.A multidisciplinary mobile ECMO team, comprising intensivists, perfusionists, nurses, and transport staff, was mobilized with specialized equipment and a comprehensive checklist to ensure readiness for adverse events.Ambulance with adequate oxygen supply was made available.Challenges: The team encountered several substantial challenges: 1. lack of surgical support during cannulation.2. restricted visual access resulting from subcutaneous emphysema.3. Immediate recirculation following cannulation that required repositioning of the cannula.4. The difficulty of optimizing space within the confined environment of a small ambulance.5. fatigue resulting from extended transportation periods. Monitoring and Transport2/4/26, 2:34 PM ABSTRACTS ECMO -IJECMO2026 file:///C:/Users/Prabhat Shukla.DESKTOP-6HO8CNO/Downloads/Page Proof/IJECMO-4(S1)-html/IJECMO-4(S1)-html/IJECMO-4(S1)/4/S(1)/10.5 1/2Continuous monitoring of both patient and ECMO circuit was maintained throughout the journey, with protocols in place to address immediate threats such as clotting, air embolism, and hemodynamic instability. Handover and Post-TransportPreparation included securing all equipment, ensuring adequate oxygen supply, and establishing robust communication between the referring and receiving hospitals.Upon arrival, the patient was safely handed over to the receiving team, and a thorough debriefing was conducted to identify areas for improvement. ConclusionThis case demonstrates that long-distance ECMO transport by road is feasible and can be performed safely in India with expert teamwork, comprehensive planning, and adaptability.The lessons learned provide valuable insights for future ECMO transfers, emphasizing the importance of readiness, rapid decision-making, and multidisciplinary collaboration in overcoming complex challenges.