🔹 Objectives

  • Understand ECMO transport as a process, not a single event.

  • Explore requirements, team composition, protocols, and challenges of mobile ECMO.

  • Emphasize training, simulation, and governance as key components.

🔹 Challenges in Mobile ECMO

  • Lack of Level 1 evidence or RCTs for ECMO transport practices.

  • Significant variability in global practices due to geography, resources, and healthcare systems.

  • Most available data are retrospective cohort studies with inconsistent definitions and outcomes.

🔹 Mission Phases (“Anatomy of the Mission”)

  1. T1: Referral to Acceptance – Decision to accept or reject the case.

  2. T2: Acceptance to Team Mobilization – Preparing the team and transport.

  3. Transport to Bedside – Includes unexpected delays, location challenges.

  4. On-Site Assessment & Cannulation – May alter original decision (ECMO/no ECMO/transport without ECMO).

  5. Post-Cannulation to Return – Loading patient, returning to ECMO center, initiating care.

🔹 Setting Up a Mobile ECMO Program

  • Start only after establishing a mature in-house ECMO service.

  • Build a well-coordinated team with clear protocols and simulation training.

  • Begin with VV ECMO cases, avoid complex VA ECMO early on.

  • Prefer OR-based cannulation for early safety and standardization.

🔹 Team Composition Considerations

  • Skillful cannulator (surgeon or ICU physician).

  • Perfusionist or ECMO-trained nurse to run the circuit.

  • Airway and infusion management personnel (ICU nurse/doctor).

  • Optimize team size (usually 4–5 members), depending on mission.

🔹 Logistics & Governance

  • Use standardized checklists for equipment, patient prep, transport.

  • Ensure adequate oxygen supply, compatible power systems, and transport safety.

  • Establish referral criteria, kit contents, and team roles clearly.

  • Implement clinical governance, quality metrics, and regular debriefings.

🔹 Simulation & Team Training

  • Continuous training using simulation scenarios.

  • Regular M&M meetings, reflections, and process evaluations.

  • Train team to adapt to unfamiliar environments and handle crises.

🔹 Key Takeaways

  • Mobile ECMO is complex, multidisciplinary, and resource-intensive.

  • Start small, build solid foundations, and scale up cautiously.

  • Look after your team: fatigue, psychological well-being, and debriefing are essential.

  • Use simulation as a core strategy for preparation and skill retention.

 

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