• Carmen Mesas Burgos, Björn Frenckner, Alexander Fletcher-Sandersjöö, and Lars Mikael Broman.
• Department of Pediatric Surgery, Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden; ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. Electronic address: Carmen.mesas.burgos@ki.se.
• J. Pediatr. Surg. 2019 Oct 1; 54 (10): 2048-2052.

BackgroundSupport on Extracorporeal oxygenation membrane (ECMO) represents the last therapeutic option in the management of respiratory failure and pulmonary hypertension refractory to treatment in patients with congenital diaphragmatic hernia (CDH).AimThe objective of this work was to present our experience of all the cases of CDH that we have transported on ECMO.Material And MethodsMedical records of patients, national and international, with CDH transported by our service on ECMO from 1997 to 2018 were reviewed.ResultsDuring 22 years, we performed 40 ECMO transports of newborns with CDH, 39 primary and one secondary. In 10% (4/40) we transferred patients from their primary hospital after the implantation of cannulae and commencement of ECMO to another center abroad owing to the lack of beds in our unit. Twenty (50%) of the transports were from a foreign country. Median transport distance was 560 (428-1381) km and the median transport time was 4.5 (4.2-6.3) h. The mode of transport was ground ambulance in 20%, helicopter in 10%, fixed wing aircraft in 62.5% and ground ambulance in Freight aircraft in 7.5%. In 40% of the transports, 20 complications occurred. In one of every four transports with complications, more than one event occurred. Most frequent complication was loss of tidal volumes (35%) and in 30% of the complications another patient related event was recorded. Equipment failure occurred in 20%, and climate problems and transport vehicle problems in 15%. No deaths occurred during transport. Venoarterial ECMO was used in 39 of the 40 cases. Survival to discharge was 87% for the entire period and long-term survival was 77%.ConclusionsLong and short distance interhospital transports of CDH patients on ECMO can be performed safely. Despite occurrence of adverse events, the risk of mortality is very low. The personnel involved must be highly competent in intensive care, physiology and physics of ECMO, cannulation, intensive care transport and air transport medicine. They must also be trained to recognize risk factors in these patients.Level Of EvidenceIII Retrospective cohort study.Copyright © 2019 Elsevier Inc. All rights reserved.

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