Transport of newborns with acute lung failure in the pre-ECMO situation and on ECMO

Background: Although ventilation and postpartal management of sick newborns has been optimized, ECMO remains a therapeutic option in the neonatal intensive care of acute lung failure. The ECMO-center Mannheim has performed about 250 ECMO cases since 1987, and currently performs about 25 ECMOs per year. 50 infants per year are evaluated for the option of ECMO therapy. Half of them are born at the center and the others are transported to the ECMO center. Some children are too ill for conventional transport, in which case transport using iNO, HFOV or mobile ECMO is necessary. In some countries special transport teams for children and for transport under ECMO have been established. In Germany only few case reports have been published.

Our experience: In the last 5 years we have transported about 50 newborns to our ECMO center, more than 70% of them needing iNO or HVOV. 5 children were transported under transport ECMO. The first transports under ECMO were done with a conventional roller pump (HL15; Jostra/marquet) and a special vehicle was needed to transport all the equipment. Those transports were difficult to organize and a lot of equipment was needed. This year for the first time we have installed a special Transport-ECMO unit on a normal Ferrno Transport system, which can be used in a standard ambulance. On the unit we use a rollerpump (NovaCirc), a Stephan ventilator, a heating pump (Aquatherm 660) and 6 perfusion pumps. Energy is generated by a UPSU (uninterrupted power supply unit). During the transport the energy comes from the vehicle. We have also used the unit for helicopter transports (bell 407). 4 of 5 newborns transported with this unit have survived and could later have been discharged, one died of secondary causes. The cannulas are placed either by surgeon from the referring hospital or by a surgeon accompanying our transport team.

Discussion: Special equipment and specially trained transport teams are necessary for transporting critically ill children. Transport under ECMO is feasible but remains a high-risk modality that should not replace the prenatal and early postnatal transport to an ECMO center. In some cases this can be a rescue therapy.