Challenges and implementation of extracorporeal membrane oxygenation transport program in a low-resource setting

Abstract

Background:

Transporting patients on extracorporeal membrane oxygenation (ECMO) is a standard practice in high-resource settings but remains limited in low- and middle-income countries due to financial, infrastructural, and staffing constraints. This study evaluated the safety, complications, and outcomes of ECMO transport in a low-resource setting.

Methods:

This retrospective study conducted ECMO transport at a tertiary hospital in Ho Chi Minh City, Vietnam, from January 2019 to January 2023. Data on demographics, transport logistics, ECMO configuration, complications, and clinical outcomes were analyzed, including subgroup comparisons between COVID-19 and non-COVID-19 patients.

Results:

Thirty-nine patients (mean age 45 years; 56.4% female) underwent inter-hospital ECMO transport over a median distance of 7.9 km. All patients survived transport, although one patient (2.6%) had a mechanical complication. Other complications recorded during ECMO support included infection in 53.8%, major bleeding in 23.1%, and pneumothorax in 5.1%. Overall survival to discharge was 69.2%. COVID-19 patients had a significantly lower discharge survival than non-COVID-19 patients (42.9% vs. 81.8%, p = 0.029)

Conclusion:

ECMO transport can be safely implemented in low-resource settings, achieving outcomes comparable to in-house ECMO support. Further research is essential to develop standardized protocols and expand ECMO networks to improve patient outcomes in resource-limited settings.