ECLS Supported Transport of Intensive Care Unit Patients—Is It Worth the Effort?

Background: Extracorporeal life support (ECLS) is an established tool to stabilize patients with therapy-refractory severe hemodynamic or respiratory failure. We have established a mobile ECMO retrieval service over the recent years at our institution. However, data on the outcome of patients receiving ECLS for transportation into tertiary hospitals is still sparse.

Methods: We have evaluated all our patients receiving ECLS in other hospitals prior to transportation in our institute.

Results: Between 2012 and 2017, we have performed 205 ECLS transport by our mobile ECLS team, with increasing numbers (2012: n = 23, 2013 n = 35, 2014 n = 29, 2015 n = 38, 2016 n = 47, 2017 n = 37). Average age of patients was 48 years with no significant differences over the years (range: 1 day–71 years). A total of 137 of patients (67%) were male. Indication for ECLS support was: respiratory failure 59%, primary cardiac failure 32%, primary pulmonary hypertension 2%, lung embolism 4%, congenital diaphragmatic hernia 1%, and unknown reasons 2%. ECLS duration was 7.5 days (± 6 days). Overall survival rate was 60.5%, increasing from 39% in 2012 to 66.7 in 2017 (p = n.s.). Survival rates were dependent per treatment with the best survival for veno-venous Support. Venoarterial ECLS patients tended to show worse outcomes, most likely to the acute severity of their underlying disease and the need for a more urgent ECLS implantation.

Conclusion: Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 hours/7 days ECLS standby for secondary and primary hospitals as a tertiary clinic. Increasing indications and total numbers for ECLS support raises the need for further studies to evaluate outcome in these patients.

No conflict of interest has been declared by the author(s).