# Pediatric Extracorporeal Membrane Oxygenation (ECMO) Transport Safety—Regional and National Experiences and Literature Review

## TL;DR

This study shows that transporting critically ill children on ECMO is generally safe, with low mortality and few serious issues.

## Contribution

The study combines single-center experience with a systematic literature review to assess pediatric ECMO transport safety.

## Key findings

- All 14 transported patients in the local cohort had no mortality or serious adverse events.
- The literature review found a transport mortality rate of 1‰ and 28% adverse events across 900 transfers.
- Experienced multidisciplinary teams can safely manage ECMO transport over varying distances.

## Abstract

Background/Objectives: Venovenous extracorporeal membrane oxygenation (VV ECMO) supports reversible respiratory failure when mechanical ventilation fails. Technological advances and specialized teams now enable ECMO initiation at referring centers, even for high-risk transports. This study aimed to evaluate the safety of pediatric patients on ECMO support during medical transfer, based on a single-center experience and a systematic review of the literature. Methods: A retrospective analysis was conducted on all pediatric patients supported with ECMO transferred from regional hospitals to our university hospital (January 2023–September 2025), focusing on transport-related mortality and morbidity. We also performed a systematic review of original articles (2015–2025) using the PubMed, Embase, and Cochrane databases. Results: Fourteen critically ill children with a median age of 16 months (range: 2 months to 11 years) and acute respiratory failure were transferred to our hospital’s Intensive Therapy Unit. All transported patients in the local cohort were supported with VV ECMO. Transport distances ranged from 5 to 520 km (median: 151 km). No mortality or serious adverse events occurred during transfer. Two technical issues were noted. In the systematic review, 14 articles met the inclusion criteria, reporting a total of 900 transfers, mainly primary ECMO initiations (779–86.6%). The number of ground transports was 337, which accounted for 37.4%. Adverse events were reported in 252 out of 900, which was 28%. One death during transport was reported (mortality: 1‰). Conclusions: All transports were safely performed by our experienced multidisciplinary mobile ECMO team. Both our experience and literature review confirmed low mortality in pediatric ECMO transport, despite potential life-threatening adverse events.