Introduction For newborns with acute lung failure the dissemination of advanced technologies like Surfactant, inhaled-nitro-oxide (iNO) and high-frequency-ventilation (HFO) has been shown to decrease the need for ECMO. But consequently also increases the need to promptly transport nonresponders with the same combination of additional therapies to an ECMO enter. For the transporting these very critically ill neonates from units that have already initiated sophisticated level of treatments to our ECMO center we provide a transport service KITS (children-intensive-transport-service).
Methods We developed a special transport unit with an ECMO-roller pump, a HFO ventilator, an iNO machine, a heating pump, 12 perfusion pumps (Braun) and a battery pack (180 minutes Power supply). This unit can be transported with an ambulance or a helicopter. For the transport team we have a 24/7 stand by service. To evaluate the safety and efficacy of the transport we documented the oxygenation index (OI) and pCO2 before and after the transport.
Results In the last two years we transported 50 neonates with acute respiratory failure per year into our ECMO center. 25% of them were supported wit HFO, 51% with iNO and 5% with ECMO during the transport (84% helicopter, 11% fix wing, 5% ambulance). No newborn died during the transport. 68% went on require ECMO within 24 h after admission our unit. The OI and pCO2 level decreased during the transport (OI: 39->35; pCO2 69, 2 mmHg ->64,7 mmHg).
Discussion Special equipment and specially trained transport teams are necessary for transporting critically ill children.