For Referring Physicians
When to Consider Consultation or Transfer to an ECMO Center
One of the most difficult tasks for a referring physician and a consulting ECMO physician is to determine when a patient needs to be transferred to an ECMO center. The majority of patients with disease states frequently treated by ECMO improve without ECMO and, therefore, referral may not be necessary. The decision to transfer is an enormous responsibility which can be eased by early consultation with the ECMO center thereby allowing both teams to decide when to move a patient. However, when a patient is at high risk for failing maximal therapy the referring physician should decide to transfer before the patient is too moribund for safe transport.
There are no standard criteria for transfer. The referring physician should begin to consider the need for ECMO when a patient who has received appropriate medical management has a Pa02 of 50-60 mm Hg when the PIP is >35 cmH20 and the FI02 is 1.00 for conventional ventilation, and after 6 hours of high frequency ventilation (neonates only) without improvement in oxygenation. After consultation with an ECMO physician the time of transfer can be determined through a team approach taking into account such items as transport time, type of transport needed, and regional availability of "ECMO beds."
Early consultation with the ECMO center will allow for the logistics of transport to be completed in a timely fashion. At the time of the initial consultation the referring center and the ECMO physician should determine a contingency plan for transport. The distance between hospitals, the availability of the ECMO bed, and the stability of the patient will be important factors in determining which team will transport and what type of transport vehicle will be used.