Xu Lei, Wang Zhiyong, Li Tong, Li Zhibo, Hu Xiaomin, Feng Quansheng, Duan Dawei, Gao Xinjing
Department of Critical Care Medicine, Tianjin Third Central Hospital, Artificial Cells Key Laboratory of Tianjin, Tianjin 300170, China, Corresponding author: Li Tong, Heart Center, Tianjin Third Central Hospital, Tianjin 300170, China, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Nov;26(11):789-93. doi: 10.3760/cma.j.issn.2095-4352.2014.11.005.
To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome (ARDS)patients whom were transported either on extracorporeal membrane oxygenation (ECMO) or on conventional ventilation, and to investigate the optimal means of inter-hospital transport.
Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO (observation group) and 6 on conventional ventilation (control group). The clinical characteristics, outcomes, transportation, vital signs before and after transportation, respiratory parameters, and Murray score between two groups were compared.
Patients in observation group were significantly older than those in control group [years: 73 (46,77) vs. 34 (23,46), Z=-2.293, P=0.022]. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluation II (APACHEII) score, Murray score, oxygenation index (PaO2/FiO2) before transportation, transit time, and transit distance [APACHEII score: 36 (33,39) vs. 27(23,35), Z=-1.830, P=0.067; Murray score: 3.5 ± 0.3 vs. 3.4 ± 0.2, t = 0.667, P = 0.524; PaO₂/FiO₂(mmHg,1 mmHg=0.133 kPa): 61 ± 14 vs. 63 ± 14, t = -0.249, P=0.809;transit time(minutes): 24 (18, 74) vs. 79 (41, 86), Z=-1.654, P = 0.098; transit distance(km): 12.9 (8.3, 71.8) vs. 72.4 (39.5, 86.8), Z = -1.651, P = 0.099]. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre, heart rate, respiratory rate, fractional inspired oxygen, inspiratory pressure and Murray score in observation group were significantly lower than those in control group [heart rate(beat/min):102 ± 16 vs. 136 ± 8, t = -4.374, P = 0.002; respiratory rate(beat/min): 23 ± 3 vs. 37 ± 2, t = -7.967, P = 0.000;fractional inspired oxygen: 0.40 ± 0.05 vs. 0.96 ± 0.09, t=-12.152, P=0.000;inspiratory pressure (cmH₂O, 1 cmH₂O = 0.098 kPa): 21 ± 1 vs. 34 ± 4, t=-6.887, P = 0.000; Murray score: 2.7 ± 0.2 vs. 3.8 ± 0.2, t = -8.573, P = 0.000], but PaO₂/FiO₂was higher than that of control group(mmHg: 278 ± 65 vs. 41 ± 5 , t = 8.075, P = 0.001). Four patients were survived in observation group, and one died from the shortage of oxygen induced lung injury deterioration during transportation. Three patients died in control group, which was directly associated with lung injury deterioration.
For patients with severe ARDS who need the support of ECMO, ECMO-assisted transfer is safer than conventional ventilation, but transfer should be implemented by experienced team.
比较体外膜肺氧合（ECMO）支持下与传统通气方式下重症急性呼吸窘迫综合征（ARDS）患者的院间转运情况及临床结局，探讨最佳院间转运方式。
分析2009年11月至2014年1月间从其他医院转至天津市第三中心医院的11例传统通气治疗无效的重症ARDS患者。其中5例患者在ECMO支持下转运（观察组），6例患者采用传统通气方式转运（对照组）。比较两组患者的临床特征、结局、转运情况、转运前后生命体征、呼吸参数及Murray评分。
观察组患者年龄显著大于对照组[岁：73（46，77） vs. 34（23，46），Z = -2.293，P = 0.022]。两组患者急性生理与慢性健康状况评分系统II（APACHEII）评分、Murray评分、转运前氧合指数（PaO2/FiO2）、转运时间及转运距离差异无统计学意义[APACHEII评分：36（33，39） vs. 27（23，35），Z = -1.830，P = 0.067；Murray评分：3.5±0.3 vs. 3.4±0.2，t = 0.667，P = 0.524；PaO₂/FiO₂（mmHg，1 mmHg = 0.133 kPa）：61±14 vs. 63±14，t = -0.249，P = 0.809；转运时间（分钟）：24（18，74） vs. 79（41，86），Z = -1.654，P = 0.098；转运距离（km）：12.9（8.3，71.8） vs. 72.4（39.5，86.8），Z = -1.651，P = 0.099]。两组患者转运前生命体征及呼吸参数差异无统计学意义。到达ECMO中心时，观察组患者心率、呼吸频率、吸入氧分数、吸气压力及Murray评分均显著低于对照组[心率（次/分）：102±16 vs. 136±8，t = -4.374，P = 0.002；呼吸频率（次/分）：23±3 vs. 37±2，t = -7.967，P = 0.000；吸入氧分数：0.40±0.05 vs. 0.96±0.09，t = -12.152，P = 0.000；吸气压力（cmH₂O，1 cmH₂O = 0.098 kPa）：21±1 vs. 34±4，t = -6.887，P = 0.000；Murray评分：2.7±0.2 vs. 3.8±0.2，t = -8.573，P = 0.000]，但PaO₂/FiO₂高于对照组（mmHg：278±65 vs. 41±5，t = 8.075，P = 0.001）。观察组4例患者存活，1例因转运途中缺氧导致肺损伤恶化死亡。对照组3例患者死亡，均与肺损伤恶化直接相关。
对于需要ECMO支持的重症ARDS患者，ECMO辅助转运比传统通气更安全，但应由经验丰富的团队实施转运。
