Activities of an ECMO center for severe respiratory failure: ECMO retrieval and beyond, a four-year experience

Abstract OBJECTIVE Beyond retrieval and management of severe Acute Respiratory Distress Syndrome (ARDS) patients, the activity of an Extracorporeal Membrane Oxygenation (ECMO) center encompasses also several other actions as on call consultations, advice and counseling to the physicians at the peripheral centers, but few data are to date available on this topic. Therefore, we describe the composite activities of retrieval and counseling of an ECMO Center since 2014. DESIGN The referral calls addressed to our ECMO center for patients with respiratory failure were prospectively recorded in a dedicated database. Referral call frequency, patient data, and results of the calls were analyzed. SETTING The 12 bed ICU of Careggi Hospital in Florence, reference ECMO center for Tuscany and center of Italy, with a mobile ECMO team. PARTICIPANTS Patients from ICUs of peripheral hospitals for whom a referral call was addressed to our ECMO center. INTERVENTIONS Many possible responses provided after a referral call, varying from ECMO team deployment to advice or to refusal. MEASUREMENTS AND MAIN RESULTS From January 1 st 2014 to December 31 st 2017, 231 calls were received at our ECMO Center, of whom 220 calls were for acute respiratory failure (ARF) cases. Throughout the study period the overall number of calls did not vary, but the percentage of ECMO retrievals decreased, while the percentage of ARF patients from peripheral hospital admitted to our ECMO center on conventional ventilation increased. Fifty-five patients were treated by our mobile ECMO team and were transferred on ECMO, 59 were admitted on ventilatory support. In flu-periods the overall calls were more frequent than in the no-flu-periods (171 calls vs 82) and more ECMO retrieval missions were deployed. CONCLUSIONS During our study period, a decreased number of patients retrieved on ECMO was observed, while patients transferred on ventilation increased, with an overall unchanged number of referred patients.