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Extracorporeal membrane oxygenation (ECMO) is a form of complete cardiopulmonary support that has been associated with improved survival in severe acute respiratory failure and refractory cardiac arrest. Current data provided by the Extracorporeal Life Support Organization demonstrate that the use of ECMO is increasing. However, ECMO remains a highly specialized and resource-intensive intervention with improved outcomes associated with higher ECMO center volumes, supporting the creation of regionalized care models. As such, the role of critical care transport is vital. Presently, there is little known about methods, crew configurations, protocols, and training for ECMO-capable transport teams. We aimed to descriptively analyze established ECMO transport programs across multiple countries. A standardized, 27-item survey was distributed to 16 transport organizations across nine different countries. The survey included items such as transport team composition, training requirements, transport method, and various technical aspects. If available, transport organizations provided ECMO transport protocols and transport configuration schematics. To date, twelve ECMO programs responded from five countries (75% response rate). Most programs (83%) offer ground, 67% offer rotor-wing, and 50% offer fixed wing transport. A minority of programs (25%) were capable of any method of transport. Nearly half (42%) of programs did not require a separate ECMO team. A physician was present always or variably during ECMO transports in 67% of programs, and 92% of transport teams had a perfusionist or ECMO specialist and a nurse. All twelve programs required initial team ECMO training, and most programs also provided continuing education on an annual basis. Of the nine transport teams capable of performing ECMO cannulation, four programs (44%) could cannulate in any prehospital or in-hospital location. Critical care transport teams play an essential role in increasing access to ECMO for patients with severe cardiopulmonary failure. There is significant variability in team composition and specialization as well as transport modality, but training requirements are commonly seen across programs. Further study is needed to define the optimal components for safe interfacility transport of ECMO patients. [ABSTRACT FROM AUTHOR]

Needle decompression of tension pneumothorax in children is a rarely encountered but potentially life-saving procedure, that is accompanied by a certain risk of injury. We evaluated the nipple as a landmark for an alternative anterior insertion site and as an aid in localizing lateral insertion sites, as well as its influence on the safety profile of the procedure. In thoracic computer tomography scans of children aged 0–10 years, the distance to the closest vital structure was compared between the traditional anterior insertion site (2nd intercostal space midclavicular line) and an alternative anterior insertion site (2nd intercostal space at the nipple line). Furthermore, the level of the nipple at the midaxillary line was investigated as guidance in quickly localizing the lateral insertion site and ensuring an insertion site high enough to avoid intraabdominal injury by the decompression needle. Additionally, correlation of these measures with age was investigated. The distance to the closest vital structure at the 2nd intercostal space was significantly bigger at the nipple line compared to the midclavicular line (right: 2.23 ± 1.13 cm vs. 0.99 ± 0.80 cm, p < 0.0001; left: 1.92 ± 1.19 cm vs. 0.81 ± 0.70 cm, p < 0.0001). At the midaxillary line, the level of the nipple was at the 4th or 5th intercostal space in the majority of children (right: 83.8%; left: 88.1%). The mean distance from the nipple to the diaphragmatic cupola was 2.63 ± 1.85 cm on the right and 3.40 ± 1.86 cm on the left hemithorax. When performing anterior needle decompression in children, we recommend inserting the needle at the more lateral insertion site at the 2nd intercostal space at the nipple line. At the lateral decompression sites, the nipple can be used as a marker for localizing the correct intercostal space for insertion and thereby ensuring enough caudad distance to the diaphragm to avoid abdominal injury. [ABSTRACT FROM AUTHOR]

Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. Method: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes. Results: During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations. Conclusions: The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS. [ABSTRACT FROM AUTHOR]