ID:123 FC-D06-4 Inter hospital ECMO Transport in Tokyo

Background: Respiratory Extracorporeal Membrane Oxygenation (ECMO) management should be centralized within specialized facilities to optimize outcomes. Inter-hospital transport facilitates this centralization for critically ill patients. This study reports on the activities of our ECMO transport program. Activities: Our ECMO transport program was established in 2016, refining our protocols over the past decade. The system utilizes a three-stage transport model: Stage 1: Acceptance and Preparation. Following a telephone consultation via our ECMO center hotline, an ECMO team is dispatched within one hour to assess patient eligibility. Simultaneously, ECMO Car (a specialized ambulance) is prepared and dispatched. Stage 2: Stabilization. If ECMO support is required prior to transfer, the ECMO team performs cannulation and initiates ECMO at the referring hospital upon arrival. If conventional respiratory support is deemed sufficient for transport, the patient is promptly packaged and transferred. Stage 3: Transport. Missions typically include at least three ECMO physicians and two clinical engineers, supported by specially trained paramedics who handle driving and coordination. The vehicle carries backup equipment–including spare consoles, a tele-ICU system, and blood gas analysis tools–to manage complications on route. For long-distance transports, tertiary emergency centers along the transport route are contacted in advance to share the possibility of emergency admission if needed. Discussion: Between January 2020 and March 2025, 106 patients with severe respiratory failure underwent ECMO initiation. In 76 of these cases, an ECMO team was dispatched to the referring hospital following consultation. 36 patients underwent ECMO transport, while 40 were transferred under conventional respiratory support prior to ECMO initiation at our center. The mean age was 55.5 years and 65% of patients survived to hospital discharge. Conclusion: This study contributes to the collective knowledge of ECMO transport programs. As we accumulate more cases and update our protocols, we anticipate further improvements in patient outcomes.