CASE STUDY: Overcoming Complexities in Neonatal ECMO Transfer

Transporting a patient necessitating Extracorporeal Membrane Oxygenation (ECMO) involves substantial medical and logistical hurdles, especially when dealing with neonates and infants. This case study underscores the complex preparation and implementation needed for transferring a six-month-old patient diagnosed with dilated cardiomyopathy and severe overall left ventricular dysfunction. This patient had undergone ECMO initiation following two cardiac arrests in a hospital in the UAE. The patient required transportation to Saudi Arabia to explore advanced treatment possibilities, including the potential for a heart transplant.

Challenges faced

Transporting an infant on Veno-Arterial (VA) ECMO presented a set of distinctive obstacles. The absence of pulsatile flow made it crucial to continuously monitor and adjust the Mean Arterial Pressure (MAP) to sustain it. Regular assessment of clotting time at the bedside was essential to prevent the formation of clots. Additionally, maintaining the ECMO system's temperature stability during transportation was of utmost importance, demanding meticulous monitoring and thorough pre-planning to counteract temperature fluctuations in various environments, including the ground ambulance and aircraft cabin.

Logistical solutions

For the transfer, we employed our specialised Cessna Citation 580 aircraft. This aircraft featured an expanded cabin space and meticulously planned seating layouts, allowing us to recreate conditions similar to the primary care facility. This setup guaranteed the smooth operation of the ECMO system during the transfer. Importantly, due to the patient's small size, we had to develop specialised transfer equipment and securement techniques. These measures were implemented to mitigate potential complications during the flight, which included ensuring the protection of the open sternotomy wound and preventing the dislodgement of cannulas.

Collaborative planning

The successful completion of the transfer relied on the combined expertise of Bluedot's multidisciplinary team. This group included neonatal intensivists, NICU nurses, ECMO specialists, perfusionists, and highly trained transport personnel. Working in close coordination with the attending medical experts, this team meticulously orchestrated the intricate details of the transfer. Through this collaborative approach, every aspect, ranging from medical procedures to logistical intricacies, received comprehensive attention and resolution.

Execution and outcome

The safe and effective transportation of the patient from the UAE to Saudi Arabia was achieved due to the thorough planning and execution by the multidisciplinary team. Their meticulous focus on every aspect, including ECMO care, temperature control, and the use of specialised transfer equipment for pediatric cases, resulted in a smooth transfer procedure. As a testament to the accomplishment of this undertaking, the patient subsequently underwent a successful heart transplant and is presently in the recovery phase.

Conclusion

The process of transporting a neonatal patient in need of ECMO is a multifaceted undertaking, requiring meticulous planning and precise execution. This case study underscores the difficulties inherent in neonatal ECMO transfer, emphasising the significance of collaborative planning, specialised equipment, and comprehensive monitoring. The positive result achieved in this instance stands as a testament to the capabilities of multidisciplinary teams in overcoming even the most intricate medical and logistical hurdles.