Transport & Retrieval

Intra-hospital transport

Staffing

All intra-hospital transports require the following staff

  • Bedside ECMO accredited ICU nurse
  • ECMO accredited ICU medical staff

Senior registrars not accredited for ECMO should be accompanied by an additional ECMO accredited staff member (ECLS Co-ordinator or ICU Consultant if possible).

All ECMO lines should be held during patient movements.

ECMO retrieval

Transport of patients requiring ECMO is feasible and safe if undertaken with care and diligence. Critically unwell patients requiring maximal ventilatory or circulatory support often destabilise during transfers. Increased patient stability once established on ECMO support facilitates safe transfer to an ECMO centre for ongoing care.

Staffing

All intra-hospital transports require the following staff

  • ICU consultant (ECMO credentialed)
  • Additional ECMO accredited staff member (ECLS co-ordinator/additional ECMO CCRN)
  • Adult Retrieval Victoria (ARV) physician
  • If on-site cannulation is required, at a minimum, 2 ECMO credentialed ICU consultants are required.

The ARV ECMO transport credentialing package must have been completed by all staff members once registered, available online. This covers both road and aviation platforms and is valid for 12 months.

Whilst the transport is a team effort, the Alfred ECMO staff will be responsible for the ECMO console operation and cannula safety, whilst the ARV physician will manage the patient’s monitoring, ventilation, haemodynamic infusion support and sedation. The ARV physician will be supported by an ARV nurse for road transports or an Ambulance Victoria (AV) flight paramedic for aviation platforms (Fixed wing / Helicopter). The ARV team will be experienced in transporting critically unwell patients and will take the lead on the logistics of moving the patient between transport platforms.

Example of ECMO retrieval with a Rotaflow console. The console is firmly strapped onto a bridge across the stretcher and the oxygenator is placed carefully between the patient’s legs while the emergency crank remains within reach (*).

Retrieval equipment & checklist

ECMO Retrieval Checklist printable PDF version

It is the responsibility of the retrieval team’s leading ICU consultant to go through the checklist and ensure completeness of the equipment prior to leaving. As listed (grey) the requirements for Rotaflow and Cardiohelp are quite different.

Key components

  • Complete ECMO console including Emergency Drive Unit (“Hand-crank”)
  • ECMO Console and corresponding HLS or PLS circuit
  • Range of cannulae for anticipated case
  • Checked transport bag and adjunct essential equipment

Shown is the retrieval bag with the top (front) pocket on the left, main compartment on the right and the side pockets are also on the right-hand side.

Blue Stash Bag

Defries – ECMO Pack

Need to collect

Patient appropriate Cannulae (x4-6)

Need to collect

Primed circuit box (PLS) / Unprimed circuit box (HLS)

Need to collect

Black Boxes – Rotaflow/ PLS circuit only

Console & power cord

Need to collect

Rotaflow Pump head

Pre-packed

Hand crank

Pre-packed

Oxygenator holder

Pre-packed

Carried Separately – Cardiohelp/ HLS circuit only

Console with 1) power cord 2) flow sensor

3) venous probe 4) pressure/temp cable

Need to collect

Hand crank

Need to collect

HLS priming guide – www.ecmo.icu – Procedures – Circuit priming

Side pocket of transport bag

Blue Transport Bag

Front pocket

Medtronic dilator/wire kit

if available

Single .025’’ guidewire (IABP exchange only)

Standard .038’’ guidewire x3

Avalon dilator kit

Amplatz wire

High flow (Y) tubing

Backflow cannula pack

Extra 3mm backflow connector (male – male)

Arterial line kit

Main: Lid

Pajunk needles x3

Scalpel of shame

USB sticks x2

Main: Left

Sterile ECMO Clamps x6

Ultrasound sleeve x2

Sterile scissors x1

Coon Dilators: F10-22 x2

Mosquito forceps

Main: Centre

Haemofiltration spikes x2

Rotaflow sensor cream

Betadine x2

O2 tubing (5m, rubber ends)

Main: Right

Latex-free gloves 7 ½ (x2)

Tegaderm dressing x8

Cable ties x8

Cable gun

Skin prep wipes x8

Griplocks x8

3-way extension taps x5

Power cord extension

Douglas straps

⅜ x ¼ & ⅜ x ½ connectors (x2 each) ¼ x ¼ with luer

⅜ x ⅜ (x3) and ⅜ x ⅜ with luer (x2)

Y connector (⅜ – ⅜ -⅜ )

Side pockets

iPhone chargers x2

Cab Charge x2

HLS priming guide

Transport checklist

Any transport in or out of hospital will require basic ECMO checks before leaving.

Printable checklist

Retrieval consideration & process

Referral hospital should collect the data required on the critical patient referral form:

https://www.alfredhealth.org.au/contents/resources/referral-forms/ICU-referral-form.pdf

All referrals should be teleconferenced via the ARV switchboard, with the ARV clinical coordinator and Alfred ECMO team able to discuss the case contemporaneously with the referral clinician. Discussion should cover patient management prior to retrieval team arrival, as well as preparation of the patient for emergent ECMO cannulation (e.g. re-siting lines: right radial arterial line (VA), remove femoral CVL if feasible, preparing skin of groins, sourcing equipment) if required.

Considerations for referring hospital

Pre-arrival of the ECMO team

At the referring institution the following items may be prepared in anticipation of supporting the patient with ECMO.

Organisational task

  • Shave groin (remove skin hair from both groins with electrical clippers and use large Elastoplast to pick up clipped hair)
  • Clearing of the bedspace as able
  • CVC / arterial line as discussed with retrieval team
  • Copy of available notes and imaging

Equipment – essentials

  • Vascular ultrasound machine ± cardiac probe
  • Large trolley (for cannulation set up)
  • Small size trolley for ECMO pump
  • Portable oxygen bottle
  • Normal Saline 2000ml + 10,000 units Heparin

  • Sterile gloves (if sizes indicated) and gowns x 2
  • Face shield with visor x 2

Equipment ideally available

  • Sterile gauze (large pack)
  • Power cord extension

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