Raspé C, Rückert F, Metz D, Hofmann B, Neitzel T, Stiller M, Gielen S, Nestler F, Ebbighausen N, Steinke T, Bucher M, Bushnaq H
Department of Anesthesiology and Critical Care Medicine, Halle-Wittenberg University, Halle (Saale), Germany
Department of Cardiac and Thoracic Surgery, Halle-Wittenberg University, Halle (Saale), Germany.
Perfusion. 2015 Jan;30(1):52-9. doi: 10.1177/0267659114531611. Epub 2014 Apr 17.
Extracorporeal membrane oxygenation (ECMO) in patients with severe pulmonary failure is able to keep patients alive until organ regeneration, until shunting out for further diagnostic and therapeutic options or until transportation to specialized centers. Nonetheless, extracorporeal techniques require a high degree of expertise, so that a confinement to specialized centers is meaningful. Following from this requirement, the need for inter-hospital transfer of patients with severely compromised pulmonary function is rising.
We report about our experience with a portable ECMO system during inter-hospital air or ground transfer of patients with cardiopulmonary failure.
The portable ECMO system was used for transportation to the center and in-hospital treatment in 36 patients with an average age of 53 years suffering from respiratory failure. Accordingly, the ECMO system was implanted as a veno-venous extracorporeal system. Pre-ECMO ventilation time was 5.2 (2-9) days. Twelve patients were transported to our institution by ground and 24 patients by air ambulance over a median distance of 46 km. With the assistance of the ECMO device, prompt stabilization of cardiopulmonary function could be achieved in all patients without any technical complications. Post-ECMO ventilation was 9.8 days. Weaning from the ECMO system was successful in 61% of all patients after a median device working period of 12.7 days; median ICU stay was 34 days and a survival rate of 64% of patients was achieved. Technical (8%) and device-associated bleeding (11%)/thromboembolic (8%) complication rates showed very acceptable levels.
Our experience demonstrates that miniaturized, portable ECMO therapy allows location-independent, out-of-center stabilization of pulmonary compromised patients with consecutive inter-hospital transfer and further in-house treatment, so that sophisticated ECMO therapy can be offered to every patient, even in hospitals with primary healthcare.
对于严重肺衰竭患者，体外膜肺氧合（ECMO）能够维持患者生命，直至器官再生、转出以获得进一步诊断和治疗选择或转至专科中心。然而，体外技术需要高度专业知识，因此局限于专科中心是有意义的。基于这一要求，肺功能严重受损患者的院间转运需求日益增加。
我们报告了在心肺衰竭患者院间空中或地面转运期间使用便携式ECMO系统的经验。
便携式ECMO系统用于36例平均年龄53岁的呼吸衰竭患者转运至中心及院内治疗。相应地，ECMO系统作为静脉-静脉体外系统植入。ECMO前通气时间为5.2（2 - 9）天。12例患者通过地面转运至我院，24例患者通过空中救护车转运，中位距离为46公里。在ECMO设备辅助下，所有患者均能迅速实现心肺功能稳定，无任何技术并发症。ECMO后通气时间为9.8天。在设备中位工作时间12.7天后，61%的患者成功撤机；中位ICU住院时间为34天，患者生存率达64%。技术并发症（8%）及与设备相关的出血（11%）/血栓栓塞（8%）并发症发生率处于非常可接受的水平。
我们的经验表明，小型化、便携式ECMO治疗能够在院间连续转运及进一步院内治疗过程中，对肺部受损患者进行独立于地点、非中心的稳定治疗，从而即使在基层医疗医院也能为每位患者提供复杂的ECMO治疗。
