Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience

Risk of COVID-19 infection among mobile extracorporeal membrane oxygenation team

Background and Aim

The transport of coronavirus-2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) is a challenging situation, especially for healthcare workers (HCWs), due to the risk of cross-infection. Hence, certain precautions are needed for their safety. The study aims to evaluate the risk of COVID-19 transmission to HCWs who transport COVID-19 patients on ECMO device.

Methods

A retrospective review of adult patients with COVID-19 infection supported with ECMO and transported by ground route to the Medical Intensive Care Unit (MICU) at Hamad General Hospital (HGH) and a survey of HCWs involved in those cases.

Results

A total of 63 HCWs of the mobile ECMO team were exposed to COVID-19-positive patients on 199 occasions. HCWs exposure time was nearly 110 h, and the total transport distance was 1018 km. During the study period, only two of the mobile ECMO HCWs tested positive for COVID-19. There was zero incidence of transfer-associated injuries or accidents to HCWs.

Conclusions

The risk of COVID-19 cross-infection to the mobile ECMO team seems to be very low, provided that strict infection prevention and control measures are applied.

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

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.