Implementation and outcomes of an urban mobile adult extracorporeal life support program

Abstract

Objective: Although extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiotomy syndrome, cardiogenic shock, and COVID-19 acute respiratory failure.

Methods: We performed a retrospective review of all patients transported to our institution through our mobile ECLS program from January 1, 2018, to January 15, 2021.

Results: Of 110 patients transported to our institution on ECLS, 65.5% required venovenous, 30.9% peripheral venoarterial, and 3.6% central venoarterial support. The most common indications for mobile ECLS were acute respiratory failure (46.4%), COVID-19-associated respiratory failure (19.1%), cardiogenic shock (18.2%) and postcardiotomy syndrome (11.8%). The median pre-ECLS Pao₂:Fio₂ for venovenous-ECLS was 64 mm Hg (interquartile range [IQR], 53-75 mm Hg) and 95.8 mm Hg (IQR, 55-227 mm Hg) for venoarterial-ECLS, whereas median pH and base deficit were 7.25 (IQR, 7.16-7.33) and 7 mmol/L (IQR, 4-11 mmol/L) for those requiring venoarterial-ECLS. Patients were transported using a ground ambulance from 50 institutions with a median distance of 27.5 miles (IQR, 18.7-48.0 miles). Extracorporeal circulation was established within a median of 45 minutes (IQR, 30-55 minutes) after team arrival. Survival to discharge was 67.3% for those requiring venovenous-ECLS for non-COVID-19 respiratory failure, 52.4% for those with COVID-19%, and 54.1% for those requiring venoarterial-ECLS.

Conclusions: Patients can be safely and expeditiously placed on ECLS across broad indications, utilizing ground transportation in an urban setting. Clinical outcomes are promising and comparable to institutional non-transfers and those reported by Extracorporeal Life Support Organization.

Keywords: COVID-19; ECLS, extracorporeal life support; ELSO, Extracorporeal Life Support Organization; ICU, intensive care unit; VA, venoarterial; VIS, Vasoactive Inotrope Score; VV, venovenous; cardiogenic shock; critical care; extracorporeal life support; extracorporeal membrane oxygenation; respiratory failure; transport.

Graphical abstract

Growth of an institutional extracorporeal life support program over 1 decade.

Figure 1

Growth of institutional adult ECLS program from 2011 to 2021. Proportion of mobile extracorporeal life support (ECLS) cases depicted as sum of annual volume. Volume for 2021 estimated based on cannulations to date (January-March 2021).

Figure 2

Distance traveled (A) from our institution to referring hospital and time (B) from arrival at referring hospital to initiation of extracorporeal life support (ECLS). Mobile ECLS cases from 2021 grouped with 2020 (n = 4). In the box plots, box borders indicate upper and lower quartiles, horizontal line indicates median, whiskers indicate nonoutlier maximum and minimum, and extra dots indicate outliers.

Figure 3

Overview of study population, mobile extracorporeal life support (ECLS) strategy, and outcomes of 110 patients transported on ECLS.

Video 1

Authors briefly discuss the implementation and outcomes of mobile extracorporeal life support. Video available at: https://www.jtcvs.org/article/S2666-2507(22)00024-4/fulltext.

Figure E1

Diagram of mobile extracorporeal life support transport circuit.