International inter-hospital covid ecmo air-transportation

ABSTRACT

To our knowledge, we would like to present you the first interhospital, international extracorporeal membrane oxygenation transport of a COVID-19 patient from Romania to Germany in November 2020. Cannulating patients at an outside facility and transporting them on ECMO is a challenge for the most experienced centers. Organizing personnel and equipment, establishing well-practiced procedures, and achieving appropriate response times to a patient in distress are complex tasks. We have retrieved 3 Covid-19 patients from Romanias different institutions. Covid-19 posed new issues to the ECMO team our Hospital. As an overregional ECMO-Center we are constantly retrieving Patients with need for extracorporeal circulation all over Germany, but because a pandemic situation is a global problem we decided to help countrys who don t have such therapy options. Exposure risk control is a very high priority. Due to patients condition and given distance (2600km) he was deemed to need airborne mobile ECMO. What was remarkable in these case is the fact that in about 4 hours after we were contacted and the ECMO indication was given, everything has been organized and with help of the Johanniter Luftrettungszentrum our team was ready for take-off. The airborne transfer lasted 3 h. During the flight, the patient remained on deep sedation (RASS-5) neuromuscular blockade and lung protective ventilation. Hemodynamics parameters remained stable with low-dose catecholamines. No complication occurred during the flight. All team members constantly used adequate PPE according to the risk of airborne infection. For the transportation of the COVID-19 patient, the crew (pilot and copilot) used droplet and contact sufficient PPE, embarked and disembarked at different times than the healthcare personnel and the patient. Because of the plane size the cabin could not be isolated from the rest of the plane.