Fig. 8.1
ECMO transport on ambulance
The installation of the patient in the vehicle is slow and under the control of each stakeholder. Once the stretcher is in the ambulance, the power supply must be reconnected as soon as possible. Most often, a power supply is available during transport, but not always at the stop of the vehicle. The equipment required for patient resuscitation (respirator, syringe pumps) can be reconnected electrically and reinstalled on board. However, one must ensure that the power output of the vehicle is sufficient to supply the outlet of all these devices and ECMO. It is sometimes necessary to use different sockets.
To prevent any falling during transport, including shocks to the ECMO equipment, it is necessary to perform such transportation with soft and smooth driving. Being a risky transfer, it is better not to be delayed during transportation and to make it as safe and smooth as possible. In this regard, in our experience, it is always better to call a police motorcycle escort.
8.3.2 Helicopter
Transporting a patient on ECMO by helicopter necessitates a compact, stable and organised installation. The space available on a helicopter is indeed very limited and often allows the accompaniment of only two or three caregivers, depending on the load weight and the size of the helicopter.
The material used must be approved for air transfer. An aviation-type power outlet may be available and supplied with the ECMO machine. If the devices are not approved, it will not be possible to connect the console on the helicopter electrically, and the proper functioning of the console and its engine during the flight cannot be guaranteed. Intra-aortic balloon pumps are not approved for air transfer.
On board, security constraints must be respected. The pilot is there to help and support teams and must respect their instructions. The space on board is very limited, and so it is necessary to transport only the equipment strictly necessary for the intervention.
8.3.2.1 Transfer on the Stretcher of the Helicopter
Unlike an ambulance transfer, not all devices accompanying the patient and which are required for his resuscitation will be reinstalled on board. Installation must be thorough and rigorous. The ECMO console is placed between the patient’s legs, the emergency hand crank is attached to it and Weiss clamps will remain with the perfusionist.
ECMO lines need to be fixed along the patient’s legs and will be installed and secured in such a way to take up as little space as possible (Fig. 8.2).
Fig. 8.2
ECMO transport on helicopter. (a) Oxygen support; (b) Power supply; (c) ECMO console between patient legs
The perfusionist must remain vigilant that no device disturbs the smooth function of the ECMO. Nothing must be put on the ECMO lines. One must check that there is no compression on cannulas that would prevent good drainage or bad reinfusion of blood to the patient.
All interhospital transport must be under surveillance, following the same vital signs as during other types of transport. These parameters must be visible and controllable at all times during patient transport. The syringe must remain accessible, and the amount of medication needed during transport should be sufficient.
Any device placed on the stretcher must be secured so as not to fall on the patient or on the ECMO console during transport.
The perfusionist must also anticipate the oxygen needs and provide assistance accordingly; the correct number of oxygen bottles must be transported.
The power supply of the ECMO console will be disconnected at the last moment before leaving the patient’s room.
8.3.2.2 Before Take-Off
The hospital team to which the patient is being transferred is notified of the arrival of the team, and if necessary an ambulance team comes to welcome the incoming team on the runway. It is important to anticipate the arrival of the helicopter during the flight, because the team on board is unreachable.
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