TOP 58 - Utilization of Extracorporeal Membrane Oxygenation Following Emergent Neonatal Transport

Publication Number: 4762.TOP 58

Aditya S. Kalluri, Boston Children's Hospital, Boston, MA, United States; Nikita Kalluri, UMass Medical School, Worcester, MA, United States; Jordan S. Rettig, Harvard Medical School, Boston, MA, United States; Brian T. Kalish, Boston Children's Hospital, Boston, MA, United States

Background: Neonates experiencing severe respiratory distress may require cardiorespiratory support with extracorporeal membrane oxygenation (ECMO). However, most labor and delivery centers and associated neonatal intensive care units (NICUs) do not have pediatric ECMO programs. Therefore, evaluation for ECMO requires emergent transfer to a regional quaternary hospital. Transfer in the postnatal period utilizes critical care transport resources, often represents a significant medical expense, and requires separation of the mother-infant dyad. As such, the decision to transfer from a tertiary NICU capable of providing maximal non-ECMO support to a regional ECMO center needs to balance the risk of cardiorespiratory decompensation against these costs. Additionally, infants may need to be triaged to either a quaternary NICU or a pediatric intensive care unit (PICU) based on ECMO capability. Better understanding of which transferred neonates ultimately require ECMO initiation can improve transport and triage decision-making. The impact of demographic and transport variables (such as transfer distance) may also contribute to need for ECMO post-transfer.

Objective: To identify which clinical and demographic characteristics are most predictive of need for ECMO and how these characteristics differ based on referral center parameters, utilizing single-center retrospective data on neonates transferred emergently to a quaternary ECMO referral center.

Design/Methods: We include neonates less than 10 days of age requiring emergent transfer to the PICU (i.e., for ECMO consideration) from 2012-2025. We exclude neonates with known diagnoses of congenital heart disease or congenital diaphragmatic hernia. Data are collected from two electronic health records used during this period, as well as a dedicated transport database. Neonatal characteristics to be analyzed include vasoactive infusion score and metrics of oxygenation at arrival, as well as delivery information and pre-transport management. Transport information includes referral center ZIP code, transport distance, and management during transport (e.g. use of neuromuscular blockade or inhaled nitric oxide). Binary logistic regression will be utilized to identify predictors of ECMO initiation, with the goal of discriminating patients who could be triaged to ECMO vs non-ECMO units at the receiving hospital. Finally, clinical characteristics will be compared as a function of referral center distance to determine if transport logistics have an impact on which patients are referred. This study has been approved by the hospital Institutional Review Board.