ID:66 FC-D06-8 Integrated Thermal Protection Throughout Transport in Subarctic Conditions for a Hemodynamically Fragile Adolescent on VA-ECMO by Military Fixed-Wing Aircraft

Background: Temperature management during interfacility transport on ECMO has not been well established. Even in experienced centers, patient-related complications occur in approximately 15% of transports, with circulatory failure in about 3%, while the incidence and hemodynamic impact of hypothermia remain unclear. In Japan, conventional ECMO heat exchangers are impractical during transport because of limited power, placing pediatric patients at risk of hypothermia in cold environments. Clinical Course: A 14-year-old boy (height 148cm, weight 25kg) with dilated cardiomyopathy developed refractory cardiogenic shock. He was placed on centrally cannulated VA-ECMO with the sternum closed, and the tubing exited via a subcostal route. His circulation was entirely dependent on VA-ECMO. Despite stable ECMO flow, he remained highly vulnerable to pulmonary edema and hemorrhage because of elevated left ventricular filling pressure and new-onset aortic valve regurgitation. Mean arterial pressure had to be tightly maintained within a narrow range of 50–55 mmHg. He required interfacility transfer to a tertiary center for LVAD implantation. The transfer distance was approximately 800 km across the sea during subarctic winter. A military fixed-wing aircraft was requested because of its ample working space, reliable electrical power supply, and wide loading access. A portable heat exchanger modified for transport was continuously used throughout transport. The circuit was insulated with aluminized thermal blankets. Ambient temperature was approximately -3 °C, and the arterial outlet temperature transiently decreased to 35.5 °C during outdoor transfer (maximum 5 minutes). However, core body temperature measured via a urinary catheter was maintained at 37 °C. ECMO flow and mean arterial pressure remained stable, with only a 5-bpm reduction in heart rate. He was transferred successfully without complications. Discussion/Conclusion: In this case, two factors made transport particularly challenging: extremely fragile hemodynamics and severe winter conditions. Comprehensive thermal protection strategies and coordinated transfer execution enabled successful transfer.