Protocol for interhospital transport of patients with an implated extracorporeal membrane oxygenation system

Sustav za izvantjelesnu membransku oksigenaciju (ECMO, eng. Extracorporeal membrane oxygenation) relativno je nova metoda koja je promijenila tijek liječenja najtežih oblika kardiorespiratornog zatajenja, a početak njene primjene bio je u liječenju pedijatrijske populacije pedesetih godina prošlog stoljeća. Iznimna uspješnost u liječenju odraslih ovom metodom pokazala se za vrijeme epidemije gripe H1N1 2009. godine te se od tada bilježe sve bolji rezultati. Sniženje mortaliteta pacijenata te dobra kvaliteta života nakon ozdravljenja postignuta je i primjenom ECMO-a za vrijeme pandemije SARS-CoV-2, koja je započela 2020. godine. Zbog složenosti metode Organizacija za izvantjelesno održavanje života (ELSO, eng. Extracorporeal life support organization) preporučuje formiranje centara posvećenih liječenju pacijenata koji trebaju ovakvu potporu, što zahtijeva i međubolnički transport iz referentnih bolnica u regionalne ECMO centre. Iako međubolnički transport bolesnika iz jedne medicinske ustanove u drugu radi više razine skrbi nije rijetka pojava te je sistematizirana ABCDE pristupom, prijevoz bolesnika uz ECMO podršku pridodaje složenosti ionako kompliciranog zadatka prijevoza kritično bolesnih. Slijedom ovoga javila se potreba za izradbom protokola koji bi omogućio sigurnu organizaciju i provedbu zbrinjavanja dviju cirkulacija, tjelesne i izvantjelesne, za vrijeme transporta. Organizacija ELSO je 2022. godine objavila smjernice za transport odraslih i pedijatrijskih pacijenata na ECMO podršci s ciljem davanja osnovnih preporuka za pružanje primarnih i sekundarnih mobilnih ECMO usluga, povećavajući tako dostupnost primjene ovog resursa. Kontrolni popisi, redovita praksa i edukacija koja uključuje simulacije, učinkovita koordinacija osoblja te alati za adekvatno zbrinjavanje teških komplikacija ključni su elementi osiguravanja uspješnog ECMO transporta, koji za rezultate tada imaju nisku smrtnost.The extracorporeal membrane oxygenation system (ECMO) is a relatively new method, which changed the course of treatment of the most severe forms of cardiorespiratory failure and had its beginning in the treatment of the pediatric population in the fifties of the last century. Prominent success in the treatment of adults with ECMO was demonstrated during the H1N1 flu epidemic in 2009 and has been growing exponentially ever since. A reduction in patient mortality and a good quality of life after recovery was also achieved with the use of ECMO during the SARS-CoV-2 pandemic, which began in 2020. Due to the complexity of the method, the Extracorporeal Life Support Organization (ELSO) recommends the creation of centers dedicated to the treatment of patients requiring ECMO, which requires interhospital transport of patients from reference hospitals to regional ECMO centers. Although the interhospital transport of patients from one medical institution to another for higher level of care is not a rare phenomenon and is systematized by the ABCDE approach, the transport of patients with ECMO support or the rescue of patients in external institutions with ECMO implantation adds an additional level of complexity to the already complicated task of transporting critically ill patients. This raises the need for a protocol for ECMO transport, which will enable the safe organization and implementation of care for two circulations, intracorporeal and extracorporeal, during transport. In 2022, ELSO publishes guidelines for the transport of adult and pediatric patients on ECMO support, which aim to provide ECMO centers with a reference for providing primary and secondary mobile ECMO services, thereby increasing the availability of this resource to critically ill patients. Checklists, regular practice including simulations and training, effective staff coordination and available tools to adequately manage difficult complications are key elements in providing safe and effective ECMO transport with low mortality outcomes