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Volume 11
Issue 3
10.3390/membranes11030210
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Article

ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms

by
Brianna A. Hildreth
1,
Giovanna Panarello
2,
Gennaro Martucci
2,*,
Fabio Tuzzolino
3,
Alberto Piacentini
2,
Giovanna Occhipinti
2,
Andrea Giunta
4,
Fabio Genco
5,
Giuseppe M. Raffa
6,
Michele Pilato
6,
Guido Capitanio
2 and
Antonio Arcadipane
2
1
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
2
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
3
Research Office, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
4
Perfusion Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
5
Emergency Rescue Service, 118 Service—Region of Sicily, 91021 Sicily, Italy
6
Cardiac Surgery Unit, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90133 Palermo, Italy
*
Author to whom correspondence should be addressed.
Membranes 2021, 11(3), 210; https://doi.org/10.3390/membranes11030210
Submission received: 16 February 2021 / Revised: 7 March 2021 / Accepted: 12 March 2021 / Published: 17 March 2021
(This article belongs to the Special Issue Challenges in the Extracorporeal Membrane Oxygenation Era)
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Abstract

The retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a vast area in southern Italy and Malta. This observational, descriptive study includes all patients that required veno–venous (V-V) ECMO and transport by a mobile team between October 2009 and May 2020. Linear and multiple logistic regressions were applied to explore the risk factors for mortality in the ICU. Kaplan–Meier estimates were generated to predict the survival in patients transported by helicopter or ambulance, and the two cohorts were compared according to their baseline characteristics. Of 122 patients transported, 89 (73%) survived to ICU discharge (50 (41%) patients were transported by ambulance, and 72 (59%) were transported by helicopter). Independent predictive factors associated with mortality in a stepwise multiple regression model were prone positioning, acute kidney injury, and the number of days spent on mechanical ventilation (MV). Kaplan–Meier estimates for survival favored the helicopter cohort (79%) rather than the ambulance cohort (64%). Patients transported by helicopter had better pre-ECMO profiles, with shorter hospital and ICU stays, a shorter duration of MV use, and higher RESP scores, which indicate better survival probabilities. ECMO transport can be carried out safely over long distances; in rural areas with underdeveloped roads, transportation via helicopter or ambulance can extend the arm of the hospital to remote areas. Early ECMO initiation can be crucial in improving survival outcomes, and when transportation is the limiting factor to starting ECMO support, it should be attempted at the earliest logistical stage possible.
Keywords: ARDS; helicopter; transportation; HEMS ARDS; helicopter; transportation; HEMS

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MDPI and ACS Style

Hildreth, B.A.; Panarello, G.; Martucci, G.; Tuzzolino, F.; Piacentini, A.; Occhipinti, G.; Giunta, A.; Genco, F.; Raffa, G.M.; Pilato, M.; et al. ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms. Membranes 2021, 11, 210. https://doi.org/10.3390/membranes11030210

AMA Style

Hildreth BA, Panarello G, Martucci G, Tuzzolino F, Piacentini A, Occhipinti G, Giunta A, Genco F, Raffa GM, Pilato M, et al. ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms. Membranes. 2021; 11(3):210. https://doi.org/10.3390/membranes11030210

Chicago/Turabian Style

Hildreth, Brianna A., Giovanna Panarello, Gennaro Martucci, Fabio Tuzzolino, Alberto Piacentini, Giovanna Occhipinti, Andrea Giunta, Fabio Genco, Giuseppe M. Raffa, Michele Pilato, and et al. 2021. "ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms" Membranes 11, no. 3: 210. https://doi.org/10.3390/membranes11030210

APA Style

Hildreth, B. A., Panarello, G., Martucci, G., Tuzzolino, F., Piacentini, A., Occhipinti, G., Giunta, A., Genco, F., Raffa, G. M., Pilato, M., Capitanio, G., & Arcadipane, A. (2021). ECMO Retrieval over the Mediterranean Sea: Extending Hospital Arms. Membranes, 11(3), 210. https://doi.org/10.3390/membranes11030210

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