Scientific Letter
Complications during intra-hospital transport of pediatric patient on extracorporeal membrane oxygenation
Complicaciones del traslado intrahospitalario del paciente pediátrico en oxigenación por membrana extracorpórea
A. Bosch-Alcaraz
, S. Alcolea-Monge, M.C. Dominguez-Delso, M. Santaolalla-Bertolin, S. Segura-Matute
Corresponding author
Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain
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Bosch-Alcaraz, S. Alcolea-Monge, M.C. Dominguez-Delso, M. Santaolalla-Bertolin, S. Segura-Matute" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Bosch-Alcaraz" "email" => array:1 [ 0 => "abosch@sjdhospitalbarcelona.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Alcolea-Monge" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Dominguez-Delso" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Santaolalla-Bertolin" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Segura-Matute" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones del traslado intrahospitalario del paciente pediátrico en oxigenación por membrana extracorpórea" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During the clinical care of pediatric patients admitted to a pediatric intensive care unit (PICU), organ damage can be serious and lead to the implementation of more complex techniques such as extracorporeal membrane oxygenation (ECMO) support. ECMO is an extracorporeal life support technique that can be used in neonatal, pediatric or adult patients with heart and/or respiratory failure that is refractory to conventional medical support or to advanced ventilation strategies.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Added to the implementation of complex therapeutic techniques, we should also bear in mind that these critically ill children may require treatment at the hospital through diagnostic and/or therapeutic interventions, that is, procedures that are associated with clinical complications and more morbimortality for the patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Fully aware of this and since the Spanish medical literature is shorthanded on this regard, we reviewed the complications derived from the intra-hospital transfer of pediatric patients on ECMO and the initiatives taken in a tertiary care pediatric hospital from October 2013 to January 2018 after the implementation of a protocol on the management of intra-hospital transfers on ECMO back in October 2013 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). We gathered the clinical histories associated with age, the clinical diagnosis of the patient that triggered the use of ECMO, the type of support used (veno-venous or veno-arterial), the location of the cannulas (cervical, femoral or transthoracic), the factors affecting the transfer (reperfusion cannula or thoracic drainage), the appearance of transfer-related complications, the consequences to these complications, and the solutions proposed.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Thus, from October 2013 to April 2017 a total of 26 ECMOs were used on 24 patients with an average 8.1 days (1–15) on ECMO support. Out of all the ECMOs analyzed, there were 16 transfers in 12 of the 24 patients included in the study (2 of them were twice on ECMO support). Nine (9) of these 12 patients were males and 3 were females with a mean age of 60 months (1–132). Three (3) patients required 2 intra-hospital transfers each and the remaining 10 required only transfer one. Seven (7) of these patients were transferred to the cath. lab, 7 to the pediatric surgical block, and 2 to the radiology unit. All of them were on veno-arterial ECMO: 10 patients due to cardiogenic shock (7 after cardiovascular surgery, 1 due to myocarditis, and 2 due to sepsis), 1 due to severe hypoxia and another one due to congenital tracheal hypoplasia. Two (2) patients were on central cannulation and the remaining ones, on peripheral cannulas: 8 patients were on exclusive cervical cannulation, and another 2 on cervical and femoral cannulas (one of them had a femoral artery reperfusion cannula). Five (5) patients were also on thoracic drainage and 2 of them remained with their chest opened. These were the complications seen: the coagulation of a femoral reperfusion cannula (that was changed after the PICU readmission), the pump accidentally stopped working because of a malfunctioning battery and the elevator had a breakdown that ended up changing the routine circuit without any repercussions for the patient. Due to all this, an alternative route for the intra-hospital transfer was proposed, a protocol was established for the thorough and routine check of the batteries, and the devices carried by the patient during PICU readmission were immediately checked.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It seems obvious that the transfer of patients on ECMO is a complex and risky procedure<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> due both to the patient's clinical severity and the great amount of devices that need to be mobilized together with the patient. Even so, the data on long-term survival with good quality of life in pediatric patients on ECMO suggest using this technique when conventional therapies fail.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Heart disease is the most common cause for ECMO support and the cath. lab was one of the most sought after units following PICU transfers in our series of cases, which is consistent with other papers reviewed on this regard.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A study conducted in Pittsburgh confirms that an experienced interdisciplinary team reduces the complications that appear during the intra-hospital transfer of patients on ECMO support.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> While such center had no adverse events during the procedure, in our case, since we have been involved with intra-hospital transfers since 2013 only, we had 3 adverse events: the coagulation of one femoral reperfusion cannula, the accidental stoppage of the pump due to a malfunctioning battery, and an elevator breakdown. This ended up changing the initial transfer protocol including the need to go over a checklist to verify the correct functioning of all the necessary equipment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore, the benefits and drawbacks of ECMO support should be assessed prior to the intra-hospital transfer of pediatric patients on ECMO. If ECMO is decided, preparations are needed beforehand,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> prior training of the personnel involved, and perfect coordination among all the members of the interdisciplinary team.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Therefore, we strongly believe in the implementation and update of specific protocols that make these transfers safe and effective while minimizing all possible risks.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bosch-Alcaraz A, Alcolea-Monge S, Dominguez-Delso MC, Santaolalla-Bertolin M, Segura-Matute S. Complicaciones del traslado intrahospitalario del paciente pediátrico en oxigenación por membrana extracorpórea. Med Intensiva. 2019;43:507–508.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Personnel required for the transfer and functions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Equipment required for the transfer \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orderly: He should be in charge of the stretcher. Two nurses: One should be in charge of the cannulas and the other one should be in charge of monitorization.Pediatric intensivist: He should be stationed between the ECMO support cart and the stretcher to make sure that the entire team moves at the same time and that the circuit is not pulling the cannulasA 4th person (nurse or doctor): He will be pushing the ECMO support cart. A 5th person (nurse or doctor): Opening way. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spinal board for the transfer of the child from the bed to the stretcher. Stretcher for the transfer.Screen and respirator during the transfer.Full oxygen tank. Ambu bag and mask adapted to the patient's age. Continuous infusion pumps with current-carrying cables. 4 protected clamps.ECMO support cart. Manual ECMO pump. Pediatric intensive care unit transfer bag with equipment and drugs. Sedation, relaxation, and cardiopulmonary resuscitation drugs. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2151936.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Equipment and personnel required for the intra-hospital transfer of patients on ECMO.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for refractory cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.A. Conrad" 1 => "P.T. 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Nakagawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-0222" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "1361" "paginaFinal" => "1367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17934123" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000008/v1_201910261026/S2173572719301444/v1_201910261026/en/main.assets" "Apartado" => array:4 [ "identificador" => "15647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000008/v1_201910261026/S2173572719301444/v1_201910261026/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301444?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 9 | 23 |
| 2024 October | 52 | 76 | 128 |
| 2024 September | 46 | 28 | 74 |
| 2024 August | 58 | 39 | 97 |
| 2024 July | 30 | 29 | 59 |
| 2024 June | 49 | 40 | 89 |
| 2024 May | 41 | 35 | 76 |
| 2024 April | 43 | 38 | 81 |
| 2024 March | 41 | 22 | 63 |
| 2024 February | 37 | 40 | 77 |
| 2024 January | 36 | 30 | 66 |
| 2023 December | 34 | 41 | 75 |
| 2023 November | 37 | 28 | 65 |
| 2023 October | 38 | 33 | 71 |
| 2023 September | 37 | 43 | 80 |
| 2023 August | 25 | 17 | 42 |
| 2023 July | 23 | 24 | 47 |
| 2023 June | 28 | 19 | 47 |
| 2023 May | 30 | 28 | 58 |
| 2023 April | 32 | 22 | 54 |
| 2023 March | 51 | 29 | 80 |
| 2023 February | 54 | 31 | 85 |
| 2023 January | 29 | 14 | 43 |
| 2022 December | 46 | 30 | 76 |
| 2022 November | 60 | 34 | 94 |
| 2022 October | 43 | 24 | 67 |
| 2022 September | 40 | 31 | 71 |
| 2022 August | 39 | 43 | 82 |
| 2022 July | 22 | 28 | 50 |
| 2022 June | 27 | 26 | 53 |
| 2022 May | 40 | 31 | 71 |
| 2022 April | 23 | 32 | 55 |
| 2022 March | 29 | 36 | 65 |
| 2022 February | 31 | 25 | 56 |
| 2022 January | 42 | 45 | 87 |
| 2021 December | 41 | 34 | 75 |
| 2021 November | 45 | 24 | 69 |
| 2021 October | 57 | 63 | 120 |
| 2021 September | 29 | 30 | 59 |
| 2021 August | 45 | 44 | 89 |
| 2021 July | 26 | 33 | 59 |
| 2021 June | 44 | 26 | 70 |
| 2021 May | 42 | 56 | 98 |
| 2021 April | 106 | 72 | 178 |
| 2021 March | 59 | 29 | 88 |
| 2021 February | 58 | 21 | 79 |
| 2021 January | 49 | 19 | 68 |
| 2020 December | 44 | 12 | 56 |
| 2020 November | 26 | 17 | 43 |
| 2020 October | 13 | 11 | 24 |
| 2020 July | 16 | 8 | 24 |
| 2020 June | 9 | 7 | 16 |
| 2020 May | 19 | 6 | 25 |
| 2020 April | 18 | 12 | 30 |
| 2020 March | 12 | 6 | 18 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 1 | 0 | 1 |
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