UW Med Flight Establishes ECMO Transport Program

March 30, 2020 2:20 PM | Sally Winkelman (Administrator)

Andrew Cathers, MD
Associate Medical Director, UW Med Flight
Univ. of WI BerbeeWalsh Dept of Emergency Medicine

UW Med Flight has established an ECMO Transport Program.  Through close partnerships with UW Health’s Critical Care and Cardiothoracic Surgery teams, Med Flight has been able to devise and implement a program wherein these critically ill patients can be safely transported.  In addition, in select situations, the team can travel to the patient, cannulate them at a referring facility, place them on ECMO, and then transport them back to UW Health.

Extracorporeal Membrane Oxygenation (abbreviated as ECMO), is a treatment that is becoming steadily more widespread and prevalent.  It is typically used for patients with severe cardiorespiratory illness.  There are two primary variants – veno-venous (VV) and veno-arterial (VA).  VV ECMO is typically used in patients with intact cardiac function but severely compromised respiratory function, such as ARDS.  VA ECMO is used for patients in cardiac arrest or severe circulatory shock, with the ECMO device supporting both the heart and the lungs.  Typically, large-bore cannulas are placed in the central vessels, and then an ECMO pump and circuit is utilized, which will circulate and oxygenate the blood.  As technology advances and ECMO transport has become more common, the ECMO devices themselves have become smaller and some are even specifically designed for ease of transport in mind.

ECMO has traditionally only been initiated and maintained in large, tertiary centers.  However, recent advances, including more widespread use of percutaneous cannulation techniques, have seen ECMO use spread to the smaller hospitals.  Many of these hospitals lack the capability to longitudinally care for ECMO patients.  In other cases, patients are placed on ECMO in order to “bridge” them to further treatment, such as Ventricular Assist Device placement or lung transplant.  Because of this, these critically ill patients often need to be transferred from the smaller facility to the destination center.  Finally, there are critically ill patients at outlying facilities who may not survive conventional interfacility transport – in these cases, it is actually safer for the patient if they are cannulated and supported by ECMO prior to moving between facilities.

Our teams have completed ECMO transports via both helicopter and ground ambulance.  Mode of transport is flexible and dictated by distance, weather conditions, and most importantly – the needs of the patient. 

Team

  • Board-Certified Emergency Medicine Physician with additional transport and ECMO training
  • Critical Care Registered Nurse with additional transport and ECMO training
  • Board-Certified Cardiothoracic Surgeon with ECMO expertise
  • Perfusionist

Vehicle

  • EC-145 Helicopter
  • Critical Care Transport Ambulances

Patient Population

  • Adult Patients already on VA or VV ECMO – either centrally or peripherally cannulated
  • Adult Patients who are not yet on ECMO but may benefit from this intervention who are at an outside facility