While some European countries have a good state organization, only three Spanish hospitals provide an extracorporeal membrane oxygenation system service for patient transfer.
- Health The emergency trip of five toilets from Malaga to Burgos to save a two-year-old boy
In recent years, the use of extracorporeal membrane oxygenation systems has increased in Spain. The ECMO (for its acronym in English) pumps blood out of the patient’s body through a circulating machine that removes carbon dioxide and returns oxygen-rich blood to the body. Thanks to this, although it is not curing the disease, the organs are allowed to rest and are assisted in their functioning when the body fails. This system is an important means of prolong survival of people who are in a serious situation waiting for an operation.
“The ECMO is a machine that temporarily supplies the functions of the heart and/or lungs when these have failed and are responding poorly to optimized conventional treatment”, explains Sylvia Belda, coordinator of the National Neonatal and Pediatric ECMO Transport Program. “It is a temporary support treatment. We use it, for example, in pictures of respiratory distressin infectionsin children with sepsiswith myocarditiswith cancer. We have also used it in children with pathology Covid-19“.
In heart surgery, publication of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE), in a study published in February 2022 it was concluded that ECMO therapy allows hospital survivals up to 50% of severe Covid-19 patients. In 2019, María Paz Fuset Cabanes, Coordinator of the Cardiac ECMO Line of the Spanish Society of Critical Intensive Medicine and Coronary Units (SEMICYUC), established that in reference centers one can speak of a 55% survival in patients with heart problems and 70% in patients with respiratory problems.
The patient who is a candidate for ECMO placement can be seen in three scenarios: need assistance in an ICU with an ECMO program, have suffered a cardiac arrest on the street, or be in a hospital that does not have the technique. In these last two cases there is a risk that the delays will be decisive for their survival. Currently there are only three centers in Spain that guarantee the transfer to your facilities of patients who need it thanks to a portable ECMO system. These are: the Hospital October 12, from Madrid; theVall d’Hebron, from Barcelona; and the Malaga Regional Hospital.
Europe is the second largest market for ECMO systems in the world, although it is a procedure widely extended to other continents. According to the coordinator of the National Neonatal and Pediatric ECMO Transport Program, countries like France and Italy have coordinated programs. Sweden is the European country with the best organizationsince the Karolinska Institute is in charge of all the ECMO transport of adults, children and neonates.
This does not occur in Spain, which lacks a central program coordinated by the Ministry of Health. The latest case, the feat of an emergency trip by five health workers who crossed the 800 kilometers that separate Malaga from Burgos to save a two-year-old boy, highlights the flaws in the Spanish health system.
“We started in the year 2012 at Hospital 12 de Octubre because we saw that it was a need not covered by the National Health System and clearly there were children who died and could have been saved. Then, from 2018-2019, they join Mlaga (which does mainly the regional transport of Andalusian) and Barcelona (which has taken charge above all of Catalonia and the Balearic Islands). Although in recent times we have crossed borders a bit,” says Belda.
The project coordinator highlights the need for more experience in transports with ECMO for the proper functioning of the initiative. “Normally they call us on the ICU pager or on the personal phone. They tell us about the child and from there they try to organize. A colleague from Burgos calls me, for example, and I see if my surgeons can go. Then I get in touch.” contact Barcelona and ask if they can take it on. Thanks to the fact that we have a common chat between the three hospitalsthe people of Malaga find out about the existence of the child and come”.
The teams depend on the patient’s autonomous community of origin to have an ambulance. “They call us from Santiago de Compostela and we have to wait for the mobile UVI to come from there, then pick us up and take us. The ideal would be to have vehicles in the available centers with the necessary energy for the operation of the heater, the ECMO, respirator and medication pumps.It has been the case that the mobile ICU does not have the capacity for all these devices and we had to improvise“.
Good coordination has helped, but much remains to be done
Teams face difficult situations in which they must stabilize the patient and transport him in ambulance, plane or helicopter. Training and experience are crucial. In this regard, the pandemic helped improve regional coordination. In Madrid, an organized and immediate program was developed for patients with pulmonary failure. According to Belda, the pandemic has strengthened ties and created networksbut the recent trip to Burgos required a twelve hour organization and it took more than twenty-four to reach the child. “When I go to bed that night, I have a real concern that we won’t make it on time.”
The initiative of the three Spanish hospitals has managed to safely transport more than 50 people thanks to ECMOs, but there is still a lot to do. “It is very nice to see that there has been a will and that in these more than 10 years calls have been answered, but a national program would avoid many problems,” explains the Coordinator of the National Neonatal and Pediatric ECMO Transport Program. And she concludes: “A previous organization would guarantee a better operation, because now they call us and we organize ourselves on the fly with the resources we have. A national program is needed. First, so that hospitals across the country know that this exists, and then so that they know where to call and that there is a team located ready to mobilize“.