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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Extracorporeal membrane oxygenation &#40;ECMO&#41; is a sophisticated therapy that has been associated to reduced mortality in patients with the most severe forms of Acute Respiratory Distress Syndrome &#40;ARDS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> It is recommended to be performed at high volume centers&#44; in order to have the best possible results&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> With the aim of equally distributing healthcare resources&#44; specialized &#8220;ECMO-Centers&#8221; should offer this therapy to patients admitted to other hospitals where ECMO cannot be done safely&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Early reports from China showed that ECMO use during the COVID-19 outbreak was anecdotal&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> nevertheless&#44; up to now&#44; more than 1900 COVID-19 patients have been treated with ECMO for COVID-19 around the world&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> As previously pointed out&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> ECMO is a finite resource and during the outbreak&#44; there are limitations to providing ECMO&#44; such as lack of material or limited staff available&#44; which may restrict the access of patients to ECMO&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the study is to evaluate the feasibility&#44; efficacy and safety of interhospital transport of patients on ECMO during the COVID-19 outbreak&#46; It is a prospective observational study that compares transport related variables of all patients retrieved on ECMO between March 15th and April 30th 2020&#44; with an historical cohort of patients transported on ECMO during the previous 6 months&#46; Controls were randomly selected from the institution&#39;s ECMO patient registry&#44; matching the number of patients included during the study period&#46; Since ECMO patients are highly selected &#40;age&#44; days of mechanical ventilation&#44; comorbidities&#44; etc&#46;&#41;&#44; no matching by other variables was done&#46; The study is performed in a tertiary ECMO center in Spain that receives referrals from 9 different hospitals in a region of 2&#46;2 million inhabitants&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the outbreak&#44; contact with the ECMO center was performed using a centralized telephone number and online registration form&#44; as usually done&#46; Specific information about ECMO in COVID-19 patients was distributed among the network hospitals&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Indications and counter-indications for ECMO in these patients were obtained from the ELSO recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> individualizing them for every patient&#46; A specific protocol for staff and equipment transportation was elaborated&#44; which included two transport vehicles&#44; and level 3 personal protective equipment &#40;long-sleeved fluid-resistant surgical gown&#44; fluid-resistant hood&#44; FFP 3 mask&#44; full face visor&#44; safety glasses&#44; 2 sets of long cuff gloves&#44; closed shoes and boot covers&#41; for every team member&#44; in order to ensure patients and staff&#39;s safety&#46; Data were obtained from the center&#39;s ECMO patient&#39;s registry&#46; The study was approved by the institutional review board&#44; and due to the observational nature of the study&#44; informed consent was waived&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary outcome is successful transport with no major complications&#58; vehicle failure&#44; pump failure&#44; oxygenator failure&#44; console failure&#44; air in circuit&#44; ventilator failure&#44; surgical site bleeding&#44; hemodynamic instability and decrease in tidal volume&#46; Secondary outcomes are&#58; patients discarded due to lack of ECMO capacity&#44; days on ECMO&#44; survival at 28 days and survival to hospital discharge&#46; Statistical analysis was performed using STATA v16&#46;1 &#40;Statacorp&#44; Texas&#44; USA&#41;&#46; Comparisons were made using <span class="elsevierStyleItalic">T</span>-test&#44; Wilcoxon Rank test and Fisher exact test as appropriate&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the study period&#44; 3614 confirmed COVID-19 patients were admitted to the region&#39;s hospitals&#46; 289 of them required ICU admission&#46; Out of them&#44; 21 patients were evaluated for ECMO and 8 &#40;38&#37;&#41; had final indication&#44; all of which were successfully retrieved on ECMO&#46; All transports were made by ground&#46; Patients&#8217; characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In the ECMO center&#44; the number of ICU beds was extended from 27 to 61&#46; During the same period&#44; another 5 in-house ECMO therapies were performed&#46; None of the considered patients were discarded for capacity reasons&#46; No significant differences in major complications during transport with non-COVID-19 patients could be identified &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; During two retrievals&#44; one of the team members had intolerance to the personal protection equipment and needed to be substituted by another team member&#46; None of the members of the team had symptoms or were tested positive in CRP for SARS-CoV-2 during the study period&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The main finding of our study is that retrieval of COVID-19 patients on ECMO during the outbreak is feasible and safe in the setting of a previously well-established mobile ECMO program&#46; To our knowledge this is the first study that directly compares interhospital transport of COVID-19 ECMO patients to a historical cohort&#46; ECMO is a life-saving technique that might be useful for treatment of refractory respiratory failure in COVID-19 patients&#46; Nevertheless&#44; up to now&#44; there are insufficient data about their outcomes&#46; Our case series shows a similar survival rate between groups&#59; however&#44; the low number of patients makes data interpretation difficult&#46; Upcoming reports from ELSO&#44; EuroELSO and Critical Care Consortium will shed some light on this issue&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To be pointed out is that COVID-19 patients had more days of mechanical ventilation prior to the start of ECMO&#46; We hypothesize this could be due to a slower evolution of the disease and&#47;or an increase in super-infections due to immunomodulatory therapy used&#44; when compared to other causes of ARDS&#44; which may lead to refractory hypoxemia and&#47;or hypercapnia in a posterior stage&#46; However&#44; late worsening of the respiratory function associated to ventilation induced lung injury is to be ruled out in COVID-19 patients aswell&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Despite the outbreak&#44; all patients considered for ECMO could be retrieved&#44; maintaining the standard of care established by the institution&#44; following the recommendations for safe transport of COVID-19 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> As previously pointed out&#44; in patients under mechanical ventilation&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> the possibility of having the space&#44; staff and stuff is a key factor for having good results in situations where the needs are close to exceed the attention capacity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; transport of COVID-19 patients on ECMO is feasible and safe in a regional ECMO center&#46; More data are necessary to determine the efficacy of ECMO in COVID-19 patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mechanical ventilation days before ECMO</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44; 3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;5&#44; 12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Compliance &#40;ml&#47;cmH</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">O&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;24&#44; 36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;27&#44; 48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Murray score</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;25 &#40;2&#46;5&#44; 3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44; 3&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Prone position before ECMO &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ECMO type &#40;VV &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ECMO configuration</span></td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femoral-Femoral &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femoral-Jugular &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Jugular dual lumen &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transport distance &#40;km&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">170 &#40;112&#44; 225&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122 &#40;112&#44; 170&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transport time &#40;minutes&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;90&#44; 135&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">90 &#40;90&#44; 105&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transport staff</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44; 3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#44; 3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CT scan on arrival &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consolidation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ground glass&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pulmonary embolism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ECMO days</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11 &#40;9&#44; 15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;5&#44; 27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Survival 28 days &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Survival to hospital discharge &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Air in circuit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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">Ventilator failure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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
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                  \t\t\t\t">Bleeding&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;12&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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">Decrease in tidal volume&nbsp;\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="char" valign="\n
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                  \t\t\t\t">2 &#40;25&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;38&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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
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                  \t\t\t\t">Hemodynamic instability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                        0 => array:2 [
                          "etal" => true
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                            2 => "P&#46; Ravindranath"
                            3 => "A&#46; Wilson"
                            4 => "A&#46; Em"
                            5 => "M&#46;M&#46; Thalanany"
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                      "doi" => "10.1016/S0140-6736(09)61069-2"
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                      "titulo" => "Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients"
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                          "autores" => array:6 [
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                            2 => "R&#46; Brtlett"
                            3 => "L&#46; Brochard"
                            4 => "R&#46; Brower"
                            5 => "S&#46; Conrad"
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                    0 => array:1 [
                      "Revista" => array:5 [
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Scientific Letter
Interhospital transport of COVID-19 patients on ECMO and comparison with historic controls
Transporte interhospitalario de pacientes con COVID-19 en ECMO y comparación con controles históricos
P. Blanco-Schweizer
Autor para correspondencia
pblancosc@saludcastillayloen.es

Corresponding author.
, J. Sánchez-Ballesteros, R. Herrán-Monge, A. Prieto-deLamo, J.A. de Ayala-Fernández, M. García-García
Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
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up to now&#44; more than 1900 COVID-19 patients have been treated with ECMO for COVID-19 around the world&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> As previously pointed out&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> ECMO is a finite resource and during the outbreak&#44; there are limitations to providing ECMO&#44; such as lack of material or limited staff available&#44; which may restrict the access of patients to ECMO&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the study is to evaluate the feasibility&#44; efficacy and safety of interhospital transport of patients on ECMO during the COVID-19 outbreak&#46; It is a prospective observational study that compares transport related variables of all patients retrieved on ECMO between March 15th and April 30th 2020&#44; with an historical cohort of patients transported on ECMO during the previous 6 months&#46; Controls were randomly selected from the institution&#39;s ECMO patient registry&#44; matching the number of patients included during the study period&#46; Since ECMO patients are highly selected &#40;age&#44; days of mechanical ventilation&#44; comorbidities&#44; etc&#46;&#41;&#44; no matching by other variables was done&#46; The study is performed in a tertiary ECMO center in Spain that receives referrals from 9 different hospitals in a region of 2&#46;2 million inhabitants&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the outbreak&#44; contact with the ECMO center was performed using a centralized telephone number and online registration form&#44; as usually done&#46; Specific information about ECMO in COVID-19 patients was distributed among the network hospitals&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Indications and counter-indications for ECMO in these patients were obtained from the ELSO recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> individualizing them for every patient&#46; A specific protocol for staff and equipment transportation was elaborated&#44; which included two transport vehicles&#44; and level 3 personal protective equipment &#40;long-sleeved fluid-resistant surgical gown&#44; fluid-resistant hood&#44; FFP 3 mask&#44; full face visor&#44; safety glasses&#44; 2 sets of long cuff gloves&#44; closed shoes and boot covers&#41; for every team member&#44; in order to ensure patients and staff&#39;s safety&#46; Data were obtained from the center&#39;s ECMO patient&#39;s registry&#46; The study was approved by the institutional review board&#44; and due to the observational nature of the study&#44; informed consent was waived&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary outcome is successful transport with no major complications&#58; vehicle failure&#44; pump failure&#44; oxygenator failure&#44; console failure&#44; air in circuit&#44; ventilator failure&#44; surgical site bleeding&#44; hemodynamic instability and decrease in tidal volume&#46; Secondary outcomes are&#58; patients discarded due to lack of ECMO capacity&#44; days on ECMO&#44; survival at 28 days and survival to hospital discharge&#46; Statistical analysis was performed using STATA v16&#46;1 &#40;Statacorp&#44; Texas&#44; USA&#41;&#46; Comparisons were made using <span class="elsevierStyleItalic">T</span>-test&#44; Wilcoxon Rank test and Fisher exact test as appropriate&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the study period&#44; 3614 confirmed COVID-19 patients were admitted to the region&#39;s hospitals&#46; 289 of them required ICU admission&#46; Out of them&#44; 21 patients were evaluated for ECMO and 8 &#40;38&#37;&#41; had final indication&#44; all of which were successfully retrieved on ECMO&#46; All transports were made by ground&#46; Patients&#8217; characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In the ECMO center&#44; the number of ICU beds was extended from 27 to 61&#46; During the same period&#44; another 5 in-house ECMO therapies were performed&#46; None of the considered patients were discarded for capacity reasons&#46; No significant differences in major complications during transport with non-COVID-19 patients could be identified &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; During two retrievals&#44; one of the team members had intolerance to the personal protection equipment and needed to be substituted by another team member&#46; None of the members of the team had symptoms or were tested positive in CRP for SARS-CoV-2 during the study period&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The main finding of our study is that retrieval of COVID-19 patients on ECMO during the outbreak is feasible and safe in the setting of a previously well-established mobile ECMO program&#46; To our knowledge this is the first study that directly compares interhospital transport of COVID-19 ECMO patients to a historical cohort&#46; ECMO is a life-saving technique that might be useful for treatment of refractory respiratory failure in COVID-19 patients&#46; Nevertheless&#44; up to now&#44; there are insufficient data about their outcomes&#46; Our case series shows a similar survival rate between groups&#59; however&#44; the low number of patients makes data interpretation difficult&#46; Upcoming reports from ELSO&#44; EuroELSO and Critical Care Consortium will shed some light on this issue&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To be pointed out is that COVID-19 patients had more days of mechanical ventilation prior to the start of ECMO&#46; We hypothesize this could be due to a slower evolution of the disease and&#47;or an increase in super-infections due to immunomodulatory therapy used&#44; when compared to other causes of ARDS&#44; which may lead to refractory hypoxemia and&#47;or hypercapnia in a posterior stage&#46; However&#44; late worsening of the respiratory function associated to ventilation induced lung injury is to be ruled out in COVID-19 patients aswell&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Despite the outbreak&#44; all patients considered for ECMO could be retrieved&#44; maintaining the standard of care established by the institution&#44; following the recommendations for safe transport of COVID-19 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> As previously pointed out&#44; in patients under mechanical ventilation&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> the possibility of having the space&#44; staff and stuff is a key factor for having good results in situations where the needs are close to exceed the attention capacity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; transport of COVID-19 patients on ECMO is feasible and safe in a regional ECMO center&#46; More data are necessary to determine the efficacy of ECMO in COVID-19 patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ns &#40;non-significant&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; iqr<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>interquartile range&#46;</p>"
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                  <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" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NON-COVID 19 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; &#40;median&#44; iqr&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COVID 19 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; &#40;median&#44; iqr&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">54 &#40;38&#44; 60&#41;&nbsp;\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="char" valign="\n
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                  \t\t\t\t">54 &#40;53&#44; 59&#41;&nbsp;\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
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex &#40;male &#37;&#41;</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;62&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleItalic">Mechanical ventilation days before ECMO</span>&nbsp;\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="char" valign="\n
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                  \t\t\t\t">3 &#40;2&#44; 3&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#44; 12&#41;&nbsp;\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">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleItalic">Compliance &#40;ml&#47;cmH</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">O&#41;</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;24&#44; 36&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;27&#44; 48&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleItalic">Murray score</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;25 &#40;2&#46;5&#44; 3&#46;5&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#44; 3&#46;25&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleItalic">Prone position before ECMO &#40;&#37;&#41;</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleItalic">ECMO type &#40;VV &#37;&#41;</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;100&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ECMO configuration</span></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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleHsp" style=""></span>Femoral-Femoral &#40;&#37;&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;50&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;62&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleHsp" style=""></span>Femoral-Jugular &#40;&#37;&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;12&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;38&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleHsp" style=""></span>Jugular dual lumen &#40;&#37;&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;38&#41;&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><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"><span class="elsevierStyleItalic">Transport distance &#40;km&#41;</span>&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">170 &#40;112&#44; 225&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">122 &#40;112&#44; 170&#41;&nbsp;\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">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transport time &#40;minutes&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">105 &#40;90&#44; 135&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;90&#44; 105&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\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
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ventilator failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Decrease in tidal volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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