Biefer Hector Rodriguez Cetina, Sündermann Simon Harald, Emmert Maximilian Yosri, Hasenclever Peter, Lachat Mario Louis, Falk Volkmar, Wilhelm Markus Johannes
Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Thorac Cardiovasc Surg. 2014 Aug;62(5):409-13. doi: 10.1055/s-0033-1351352. Epub 2013 Aug 29.
With the growing number of outpatients on ventricular assist devices (VADs), there is an increasing need for "home discharge programs." One important feature is a 24-hour telephone service. In our center, the perfusionists run a so-called "hotline" for all of our VAD patients. This study analyzes the hotline calls with regard to frequency, the reason for calling, and the type of action undertaken.
Over a period of 5 years, 16 (12 EXCOR and 4 INCOR; Berlin Heart, Berlin, Germany) of 33 VAD patients (48%) were discharged and instructed to use the "hotline" service. All the calls received by the perfusionists were reviewed. We classified the calls into three levels according to the severity of the problem: Level (L) 1 = assistance provided by the perfusionist alone; L2 = calls requiring discussion with the surgeon on duty and/or visit to the outpatient clinic ahead of time; and L3 = immediate action and/or admission to the hospital.
Over a period of 2,890 outpatient days (7.9 years), a total of 26 calls were registered. There were 0.9 calls per 100 patient days and 1.6 calls per discharged patient. Out of the 26 calls, 14 calls (54%) were classified as L1, 8 (31%) as L2, and 4 (15%) as L3. The most frequent reasons for L1 or L2 calls were fibrin deposits in the EXCOR pump chamber (39%), followed by battery dysfunction (19%). L3 calls were related to dysfunction of the EXCOR driving units in three cases and to an EXCOR pump chamber disconnection, which the patient did not survive.
The institution of a hotline is an essential component of a VAD outpatient program. It provides a certain level of safety for the patient, although a residual risk remains.
随着使用心室辅助装置（VAD）的门诊患者数量不断增加，对“家庭出院计划”的需求也日益增长。其中一个重要特征是提供24小时电话服务。在我们中心，灌注师为所有VAD患者运营一条所谓的“热线”。本研究分析了热线电话的拨打频率、拨打原因以及采取的行动类型。
在5年期间，33例VAD患者中有16例（12例使用EXCOR，4例使用INCOR；德国柏林心脏公司产品）出院，并被指导使用“热线”服务。对灌注师接到的所有电话进行了回顾。我们根据问题的严重程度将电话分为三个级别：1级（L1）=仅由灌注师提供协助；L2=需要与值班外科医生讨论和/或提前到门诊就诊的电话；L3=立即采取行动和/或住院治疗。
在2890个门诊日（7.9年）期间，共记录到26次电话。每100个患者日有0.9次电话，每位出院患者有1.6次电话。在这26次电话中，14次（54%）被归类为L1，8次（31%）为L2，4次（15%）为L3。L1或L2级电话最常见的原因是EXCOR泵腔内出现纤维蛋白沉积（39%）,其次是电池功能障碍（19%）。L3级电话中有3例与EXCOR驱动单元功能障碍有关，1例与EXCOR泵腔断开连接有关，该患者未能存活。
设立热线是VAD门诊计划的重要组成部分。它为患者提供了一定程度的安全保障，尽管仍存在残余风险。
