Complications during extracorporeal membrane oxygenation transfer in Argentina: A multicenter observational study.

Background: There is a lack of documented cases regarding complications during ECMO transfer in middle-income countries. Using portable ECMO devices facilitates patient transport but entails significantly higher costs, necessitating evidence of their practical utility. This study aims to describe complications during ECMO transfer in Argentina and to compare complication rates between the integrated portable ECMO and non-portable ECMO systems.

Methods: A multicenter observational retrospective study was conducted across four high-complexity hospitals in Argentina. Patients over 18 years old who underwent ECMO transfer between January 2017 and July 2023 were included. Complications were classified based on the Ericsson severity classification, a widely accepted system that categorizes complications based on their severity and the need for immediate organ support. The effect of the ECMO systems (portable and non-portable ECMO system) on complication rates was assessed using logistic regression weighted by inverse probability weighting (IPWT) analysis after propensity score assessment to adjust for confounders.

Results: The study included 65 patients who were transferred for ECMO. Complications occurred in 40% (95%CI: 28%, 52%; n=26) of transfers, with grade 2 complications being the most prevalent at 20% (95%CI 11%, 32%; n=13). Integrated portable ECMO systems were associated with fewer complications during ECMO transfer, showing a crude OR of 0.25 (95%CI 0.08, 0.75), and after adjustment by IPWT, an OR of 0.27 (95%CI 0.08, 0.93).

Conclusions: ECMO transfers in middle-income countries exhibit complication rates similar to those in high-income countries. Our study found fewer complications in transfers using integrated portable ECMO systems and those involving distances exceeding 100 km. These findings suggest that the use of portable ECMO systems, despite their higher costs, may be beneficial in reducing complications during patient transport in middle-income countries.