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Adverse Events during Inter-Hospital Transports on Extracorporeal Membrane Oxygenation.

Adverse Events during Inter-Hospital Transports on Extracorporeal Membrane Oxygenation.
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Ericsson A, Frenckner B, Broman LM,


Ericsson A, Frenckner B, Broman LM, (click to view)

Ericsson A, Frenckner B, Broman LM,

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Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors 2017 02 06() 1-8 doi 10.1080/10903127.2017.1282561
Abstract
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published.

METHODS
To shed light on this matter, all medical transport records from transports on ECMO between January 2010 and June 2016 were analyzed. The data was classified in constituent groups and categorized to risk groups.

RESULTS
During the study period, 536 transports on ECMO were performed. The transport records could be identified in 514 of these cases (95.9%). In 163 (31.7%) transports 206 adverse events occurred. In 34 transports two or more adverse events passed on the same trip. No deaths occurred during transport. Sixty-five percent (134) of the complications were Patient related; the most prominent was loss of tidal volume with or without fluid flooding of the lung (n = 57, 43%). Lack of control of equipment was the most common Staff related flaw. Causes due to Equipment/technical (n = 30) could be traced to 14.6% of the events. Vehicle/transportation related complications were reported from 26 transfers, a sub-group in which 50% of the reports concerned malfunction of Ambulance utility/electrical, or Wrong ambulance size at hospital or airport.

CONCLUSIONS
If transporting on ECMO high-risk or sudden threat-of-life situations are inevitable and have to be dealt with immediately, sometimes within seconds. A well-trained staff and an experienced high-volume organization are recommended. Key words: extra corporeal membrane oxygenation; ECMO, transport; adverse event; complication.

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