Interhospital Transport of Children Requiring Extracorporeal Membrane Oxygenation Support for Cardiac Dysfunction Antonio G. Cabrera, MD,* 1 Parthak Prodhan, MBBS, †1 Mario A. Cleves, PhD, † Richard T. Fiser, MD, † Michael Schmitz, MD, † Eudice Fontenot, MD, † Wesley Mckamie, CCP, ‡ Carl Chipman, CRNFA, ‡ Robert D.B. Jaquiss, MD, ‡ and Michiaki Imamura, MD, PhD ‡ *Department of Pediatrics, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine. Houston, Tex, USA; † Department of Pediatrics, Sections of Cardiology, Pediatric Critical Care Medicine, Congenital Cardiac Anesthesiology and ‡ Pediatric Cardiothoracic Surgery, College of Medicine–University of Arkansas Medical Sciences, Arkansas Children’s Hospital, Little Rock, Ark, USA ABSTRACT Objective. Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO. Our center has a 20-year experience in carrying out such transports. The purpose of this study was twofold: (1) to review our experience with pediatric cardiac patients undergoing CM-ECMO and (2) identify risk factors for a composite outcome (defined as either cardiac transplan- tation or death) among children undergoing CM-ECMO. Design. Retrospective case series. Setting. Cardiovascular intensive care and pediatric transport system. Patients. Children (n = 37) from 0–18 years undergoing CM-ECMO transports (n = 38) between January 1990 and September 2005. Interventions. None. Measurements and Main Results. A total of 38 CM-ECMO transports were performed for congenital heart disease (n = 22), cardiomyopathy (n = 11), and sepsis with myocardial dysfunction (n = 4). There were 18 survivors to hospital discharge. Twenty-two patients were transported a distance of more than 300 miles from our institution. Ten patients were previously cannulated and on ECMO prior to transport. Thirty-five patients were transported by air and two by ground. Six patients underwent cardiac transplantation, all of whom survived to discharge. After adjusting for other covariates post-CM-ECMO renal support was the only variable associated with the composite outcome of death/need for cardiac transplant (odds ratio = 13.2; 95% confidence interval, 1.60–108.90; P = 0.003). There were two minor complications (equipment failure/dysfunction) and no major complications or deaths during transport. Conclusions. Air and ground CM-ECMO transport of pediatric patients with refractory myocardial dysfunction is safe and effective. In our study cohort, the need for post-CM-ECMO renal support was associated with the composite outcome of death/need for cardiac transplant. Key Words. ECMO; Mobile; Cardiac; Children; Transplant Background E xtracorporeal membrane oxygenation (ECMO) is an important support modality for patients with refractory hemodynamic instability, which can develop in the setting of congenital heart disease, systemic illness, or postcardiotomy. 1–5 Many centers are capable of emergently deploy- ing ECMO support in children with significant hemodynamic instability, but may not have the resources to provide prolonged circulatory support or perform cardiac transplantation. Transport of Institution where study was performed: Arkansas Chil- dren’s Hospital. Financial Disclosure: None. 1 Both authors contributed equally to the work. 202 © 2011 Copyright the Authors Congenital Heart Disease © 2011 Wiley Periodicals, Inc. Congenit Heart Dis. 2011;6:202–208