This study is aimed to describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation (EMO) to a regional pediatric intensive care transport service and identify clinical features at initial referral that predict the need for EMO. A retrospective analysis was done with the help of prospectively collected data from specialist pediatric intensive care transport service based at a large U.K. extracorporeal membrane oxygenation center. The clinical and demographic data at the time of referral, 90-day mortality status, and referral outcome were extracted. Both univariate and multivariate analyses were used to identify clinical features at initial referral in patients that predicted the need for EMO.
Only 203 out of the 253 extracorporeal membrane oxygenation referrals were included, out of which:
- 31.5% received extracorporeal membrane oxygenation.
- 8.8% were accepted for extracorporeal membrane oxygenation but died before extracorporeal membrane oxygenation could be provided.
- 59.6% did not receive extracorporeal membrane oxygenation.
The transport team mobilized in 66.9% referrals ; conventional transport to an extracorporeal membrane oxygenation center was successful in 93.4%, while 6.6% were too unstable to transport. The 90-day mortality for the group was 17.7%. Ultimately, 59.6% of the referrals continued on conventional management; however, 8.8% of the referrals died before EMO could be provided.
In conclusion, earlier referral for EMO, targeted referral triage using primary diagnosis, and access to mobile EMO services and faster mobilization of transport teams are essential factors that could improve outcomes.