Transport

Thi Ngoc, Thao Pham1,2; Thi Phan, Xuan3; Pham Minh, Huy1; Anh Mai, Tuan2; Hoang Kim Trieu, Ngan1; Nguyen Manh, Tuan1; Quang Huynh, Dai2; Hai Le, Yen Nguyen1; Viet Ngo, Anh1; Qui Nguyen, Hung1; Ba Nguyen, Duy1; Thanh Kha, Tuan1; Le Ngoc, Toan1; Tran Thanh, Linh1

1Department of Critical Care Unit, Cho Ray Hospital, Ho Chi Minh, Vietnam.

2University of Medicine and Pharmacy at Ho Chi Minh, Ho Chi Minh, Vietnam.

3Department of Emergency and Critical Care Unit, Ho Chi Minh, Vietnam

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is an advanced life-support technique for cardiopulmonary failure refractory to conventional treatment. In a resource-limited setting, the implementation of a mobile ECMO program can be challenging, particularly in difficult-to-transfer areas such as mountainous and rural regions, due to the complexity of the procedure, the requirement for a highly trained team, and costly equipment.

Methods: A retrospective study review of four-year experiences in setting up mobile ECMO in a Southeast Asian country.

Results: A total of 369 patients were ECMO-supported from January 2019 to January 2023 in our institute. Among the 39 patients who underwent mobile ECMO, venovenous ECMO was performed in 92.3% of cases. All patients were transferred by ambulance with an average distance of 28.0 kilometers, and the maximum transferring distance from the hospital in a mountainous area of 512 kilometers. During transport, one mobile ECMO case was managed by utilizing a hand crank due to power supply failure, with no subsequent complications. The most common complication during mobile ECMO was an infection, occurring in 53.8%. Furthermore, 51.2% of the patients required renal replacement therapy. The overall mortality rate was 33.5%. The mortality rate in the ARDS-COVID-19 group was higher than that of the ARDS-non-COVID-19 group, being 57.1% and 18.2%, respectively (p =0.029).

Conclusion: Mobile ECMO was proved to be an effective, safe, and valuable tool in resource-restrain countries. However, further exploration and integration of mobile ECMO into clinical practice are necessary to optimize its implementation and transportation protocols to improve patient outcomes.