Roger D, Dudouit J-M, Résière D, Mehdaoui H, Courcier D, Villain L, Léonard C, Roques F, Lebreton G
Samu-Smur 972, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, Fort-de-France cedex, Martinique.
Ann Fr Anesth Reanim. 2013 May;32(5):307-14. doi: 10.1016/j.annfar.2013.03.003. Epub 2013 May 1.
The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean.
All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected.
Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34years old [16-64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7-29km), seven by helicopter (190-440km), and eight by plane (440-1430km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted.
Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable.
在法属西印度群岛，危重症患者的转运是一项切实的挑战；为确保医疗服务的地域连续性，法兰西堡医院心脏外科创建了一个移动体外膜肺氧合/体外生命支持（ECMO/ECLS）单元。我们这项工作的目的是描述法属加勒比地区在院际间转运接受ECMO/ECLS支持患者时的后勤、技术和财务方面情况。
纳入2009年12月29日至2011年9月30日期间在法属安的列斯-圭亚那地区接受ECMO/ECLS支持后被转运回法兰西堡医院的所有患者。收集体外支持的指征和类型、出发地点、运输车辆类型、转运期间的并发症、出院后的生存情况以及直接费用。
19例患者在远离我们中心的地方由我们的移动单元提供支持（男女比例0.63，中位年龄34岁[16 - 64岁]）。12例因难治性急性呼吸窘迫综合征接受ECMO支持，7例因难治性心源性休克接受ECLS支持。4例患者通过救护车转运（7 - 29公里），7例通过直升机转运（190 - 440公里），8例通过飞机转运（440 - 1430公里）。转运期间无患者死亡。这些转运过程中未发生重大不良事件。15例患者存活。进行了经济评估。
在我们地区，在完全安全的条件下，通过陆路或空中对接受ECMO/ECLS支持的患者进行院际转运在技术上是可行的。这项活动的预先协调有助于使其费用可控。
