ECMO transports perspectives on organization and patient management: A narrative review

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is an established life support technique for refractory acute cardiorespiratory failure in children and adult patients. However, ECMO support is provided only by specialized centers; therefore, demand for ECMO transport retrieval services is increasing. Mobile teams assess, accept, implant ECMO, and then transport for continued support at an ECMO center.

Aim

To provide an updated practical review to support ECMO teams for safe and effective transports.

Material and methods

We retrospectively reviewed literature limited to ECMO transport published between January 2014 to October 2025.

Results

Forty-five manuscripts were included in this narrative review. Patient selection focused on reversible, refractory respiratory or cardiac failure not responding to maximal conventional therapy. Time to reach the referring hospital is the most frequent factor limiting the feasibility of transport; both ground ambulances and aircraft were the most common means used, depending on distance. Weather and road conditions may influence transport safety. Familiar equipment was generally used during transport, but with adaptation and certification for transport. Team experience and training were important factors for safe transport since complications frequently occurred, requiring fast decision and action. Foreign country missions required involvement of insurance, legal, and administrative support.

Conclusions

Regional, national, and international inter-hospital ECMO transports can be conducted safely. Preparation of ECMO transport services regarding adapted equipment, checklists, and comprehensive training for ECMO team members is essential to ensure secure transport, enabling early identification and appropriate management of adverse events. International transports operate within different regulatory frameworks and therefore require special considerations.