“Pushing Geographic Boundaries: Interfacility transport and remote extracorporeal membrane oxygenation cannulation of patients during COVID-19 pandemic”

Abstract

Amidst the pandemic, geographical boundaries presented challenges to those in need of higher levels of care from referral centers. Authors sought to evaluate potential predictors of treatment success; assess our transport and remote cannulation process; and identify transport associated complications. Retrospective series of critically ill adults with COVID-19 transferred by our Extracorporeal Membrane Oxygenation (ECMO) team 24 March 2020 through 8 June 2021. Descriptive statistics and associated interquartile ranges (IQR) were used to summarize the data. Sixty-three patients with COVID associated acute respiratory distress syndrome (ARDS) requiring ECMO support were admitted to our ECMO center. Mean age was 44 years old (SD 12; IQR 36–56). 59% (n = 37) of patients were male. Average body mass index was 39.7 (SD 11.3; IQR 31–48.5). Majority of patients (77.8%; n = 35) had severe ARDS. Predictors of treatment success were not observed. Transport distances ranged from 2.2 to 236 miles (median 22.5 miles; IQR 8.3–79); round trip times from 18 to 476 min (median 83 min; IQR 44–194). No transport associated complications occurred. Median duration of ECMO support was 17 days (IQR 9.5–34.5). Length of stay in the Intensive Care Unit (median 36 days; IQR 17–49) and hospital (median 39 days; IQR 25–57) varied. Amongst those discharged, 60% survived.