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DOI: 10.1055/s-0045-1809766
Remote ECMO implantation as bridge-to-lung transplant or bridge-to-decision
Authors
Background Extracorporeal membrane oxygenation (ECMO) is often the only life-saving option for patients with end-stage lung disease, serving as a bridge to recovery, decision-making, or transplantation. However, ECMO resources are typically centralized in tertiary hospitals capable to provide adequate infrastructure and personnel. To address this, several countries have implemented mobile ECMO programs, enabling remote ECMO initiation and safe patient transport to specialized centers. This study summarizes our first experience with remote veno-venous ECMO (vvECMO) implantation for patients with acute respiratory failure.
Methods & Materials Eligible patients included those with acute respiratory failure who were potential lung transplant candidates but lacked access to ECMO at their local institution. A structured protocol was established to standardize ECMO implantation and inter-hospital transport. We retrospectively analyzed our initial experience from April 2020 to March 2025.
Results Six patients with respiratory failure were included, with underlying conditions such as COVID-19 ARDS (n=1), exacerbation of interstitial lung disease (n=4), and COPD (n=1). vvECMO cannulation was performed remotely using dual-lumen cannulas in the right jugular vein (n=4) or conventional femoro-jugular cannulation (n=2). Three patients underwent awake implantation, while three were sedated and ventilated. Patients were transported via helicopter (n=4) or ambulance (n=2), covering a median distance of 75 km (range: 7–614 km). ECMO initiation and transport proceeded without complications or adverse events. After a median ECMO duration of 9.5 days (range: 4–36), three patients died, one recovered, and two successfully underwent double lung transplantation.
Conclusion This study demonstrates the feasibility of safe remote vvECMO implantation and subsequent transport to specialized centers for patients with respiratory failure. Further standardization of protocols in collaboration with other institutions may improve ECMO accessibility, timing, and patient outcomes in hospitals without direct ECMO resources.
Publikationsverlauf
Artikel online veröffentlicht:
25. August 2025
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