243 - Transport Factors that Correlate with Utilization of ECMO in Neonates

Publication Number: 4239.243

Ashley L. Orr, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jason Z. Niehaus, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Samantha R. O'Neill, Indiana University School of Medicine, Zionsville, IN, United States

Background: There are over 68,000 neonatal transports reported in the United States annually. Hundreds of these referrals are for critically ill neonates who require extracorporeal membrane oxygenation (ECMO) evaluation. Published data regarding neonatal transport has reported up to 31% decompensation rates during transfer with no current literature describing neonatal transports for ECMO evaluation.

Objective: This project seeks to describe the factors present before and during transport that ultimately impact utilization of ECMO in neonates.

Design/Methods: This is an IRB exempt retrospective cohort study analyzing neonatal transports from 2021-2024 in Indiana for ECMO evaluation at a Level IV newborn intensive care unit (NICU). Electronic medical records were reviewed with data obtained regarding demographic information, clinical information upon arrival of transport team to referral hospital and at time of admission, as well as clinical outcomes. Neonates who required treatment with ECMO or died prior to cannulation were compared to those not managed with ECMO. Analysis was performed via Microsoft Excel.

Results: Fifty-five neonates were transferred for ECMO evaluation with 20 in the ECMO group vs 35 in the non-ECMO group. There were no statistically significant differences in demographics between the groups (Table 1). Analysis of transport data showed that the level of care of referral hospital was significantly different between the two groups (p=0.043) and the ECMO group had a higher proportion of transport via rotor (65% vs 28.6%, p=0.019) (Table 2). The ECMO group had a higher mean Vasoactive-Inotropic Score (VIS) pre-transport (22 vs 0, p< 0.01). Further, the ECMO group were on average receiving 2 vasoactive medications prior to transport compared to 0 (p < 0.01). The impact of transport by comparing net change in hemodynamic factors for patients is presented in Table 3. The ECMO group showed increased use of vasoactive medications while simultaneously not having a change in VIS. FiO2 use was nearing significance with no change in the ECMO group and improvement noted in the non-ECMO group (0 vs -3, p=0.052). There were no deaths reported during transport.

Conclusion(s): The decision to transport neonates for escalation of care is multifaceted and not without risk. Our data show that VIS score and vasoactive use could be helpful in predicting need for ECMO. Transporting ECMO referral patients, while perceived to be risky, is a safe practice in the hands of a skilled transport team. Inability to wean Fio2 and vasoactive use on transport could be associated with ECMO use.

Table 1
Demographic data.

Table 2
Transport data and hemodynamic data pre-transport and at time of admission.

Table 3
Net change in hemodynamic factors (presented as a median) from time of arrival of transport team at sending hospital to admission at Level IV NICU.