Custom-made mobile steel carts or cradles have been developed by each ECMO centre to easily load all the equipment on the patient and to allow safe loading/unloading on the ambulance. Our custom-made steel cart (Fig. 39.1) extends in height (100 cm) and provides two supports on two levels. It mounts on the spinal board over the patient’s feet and allows transportation of the ECMO unit (driving pump, heater and console), an ICU ventilator and an ICU monitor. Moreover, a especially designed iron post allows holding of infusional pumps, pressure bags and fluids. A power strip is fixed on a post to organize electrical cables. Patient-cart unit is then secured and loaded on ambulance stretcher (maximum tolerance 250 kg). When loaded on the ambulance (Fig. 39.2), it may be secured with additional ropes to avoid rolling of the patient-cart unit and displacement of the equipment.

All the equipment needed for cannulation, priming of ECMO circuit and emergency procedures are listed in checklists and organized into backpacks. Backpacks and electrical equipment must be checked before departure, and materials must be replaced immediately after use.

On arrival the ECMO team gets clinical informations from the referring medical staff and takes charge of the patient. It’s important to avoid unnecessary delays of referral; the ECMO team will attempt to get the most stable clinical condition after ECMO is started and the patient is positioned supine on the stretcher. The cart will be placed on the stretcher and carefully loaded with special attention to weight-balance the cart. All the equipment will be checked again while on battery energy supply and tightly secured. Only after these procedures the patient will be moved to the ambulance. Moving the patient to the ambulance, oxygen to both the ECMO membrane lung and the ventilator will be provided by at least two small oxygen tanks. Power and gas supplies will be replaced by ambulance power inverter and gas tanks once loaded.

The ECMO team is multidisciplinary and should be staffed by experienced and trained personnel. The team must be able to apply and run ECMO via peripheral venous-venous or venous-arterial cannulation and to front serious adverse events (see below). The number and composition of the group may vary from a minimum of three [5, 17] up to 15 [7, 10, 18], depending on the distance of the referring hospital (i.e. need for two drivers, support vehicles) and the presence of trainees, logistics and local practices. More frequently, the team includes at least a perfusionist to provide ECMO circuit set-up and management, two ECMO skilled physicians (surgeons and/or critical care physicians or both), one or two critical care nurses and drivers. Although Seldinger cannulation technique is preferable, many groups include a cardiac surgeon in order to provide, when needed, direct vascular cutdown or rescue thoracotomy.