Background/Objectives: Venovenous extracorporeal membrane oxygenation (VV ECMO) supports reversible respiratory failure when mechanical ventilation fails. Technological advances and specialized teams now enable ECMO initiation at referring centers, even for high-risk transports. This study aimed to evaluate the safety of pediatric patients on ECMO support during medical transfer, based on a single-center experience and a systematic review of the literature. 

Methods: A retrospective analysis was conducted on all pediatric patients supported with ECMO transferred from regional hospitals to our university hospital (January 2023–September 2025), focusing on transport-related mortality and morbidity. We also performed a systematic review of original articles (2015–2025) using the PubMed, Embase, and Cochrane databases. 

Results: Fourteen critically ill children with a median age of 16 months (range: 2 months to 11 years) and acute respiratory failure were transferred to our hospital’s Intensive Therapy Unit. All transported patients in the local cohort were supported with VV ECMO. Transport distances ranged from 5 to 520 km (median: 151 km). No mortality or serious adverse events occurred during transfer. Two technical issues were noted. In the systematic review, 14 articles met the inclusion criteria, reporting a total of 900 transfers, mainly primary ECMO initiations (779–86.6%). The number of ground transports was 337, which accounted for 37.4%. Adverse events were reported in 252 out of 900, which was 28%. One death during transport was reported (mortality: 1‰). 

Conclusions: All transports were safely performed by our experienced multidisciplinary mobile ECMO team. Both our experience and literature review confirmed low mortality in pediatric ECMO transport, despite potential life-threatening adverse events.