Menaker Jay, Dolly Katelyn, Rector Raymond, Kufera Joseph, Lee Eugenia E, Tabatabai Ali, Rabinowitz Ronald P, Kon Zachary N, Sanchez Pablo, Pham Si, Herr Daniel L, O'Connor James V, Stein Deborah M, Scalea Thomas M
From the Department of Surgery, University of Maryland School of Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center (J.M., E.E.L., J.V.O., D.M.S., T.M.S.); Peri-operative Service, University of Maryland Medical Center (K.D., R.R.); National Study Center for Trauma and EMS (J.K.), Department of Medicine (A.T., R.P.R., D.L.H.), and Department of Surgery, Division Cardiac Surgery, University of Maryland School of Medicine (Z.N.K., P.S., S.P.).
J Trauma Acute Care Surg. 2017 Sep;83(3):438-442. doi: 10.1097/TA.0000000000001524.
The use of venovenous extra corporeal membrane oxygenation (VV ECMO) for acute respiratory failure (ARF)/acute respiratory (ARDS) has increased since 2009. Specialized units for patients requiring VV ECMO are not standard and patients are often cohorted with other critically ill patients. The purpose of this study was to report the outcome of adult patients admitted in 2015 to the lung rescue unit, which, to our knowledge, is the first intensive care unit in the United States that has been specifically created to provide care for patients requiring VV ECMO.
Data were collected on all patients admitted to the lung rescue unit on VV ECMO between January 1, 2015, and December 31, 2015. Demographics, medical history, pre-ECMO data, indication for VV ECMO as well as duration of ECMO and survival to decannulation and discharge were recorded. Means (± standard deviation) and medians (interquartile range [IQR]) were reported when appropriate.
Forty-nine patients were enrolled. Median age was 48 years (IQR, 32-57). Median PaO2/FIO2 ratio before cannulation was 66 (IQR, 53-86). Median ventilator days before cannulation was 2 (IQR, 1-4). Median time on VV ECMO for all patients was 311 hours (IQR, 203-461). Thirty-eight (78%) patients were successfully decannulated with 35 (71%) patients surviving to hospital discharge.
The use of VV ECMO for ARF/ARDS is increasing. We have demonstrated that a dedicated multidisciplinary intensive care unit for the purpose of providing standardized care with specialized trained providers can improve survival to discharge for patients that require VV ECMO for ARF/ARDS.
Therapeutic, level V.
自2009年以来，静脉-静脉体外膜肺氧合（VV ECMO）在急性呼吸衰竭（ARF）/急性呼吸窘迫综合征（ARDS）中的应用有所增加。为需要VV ECMO的患者设立的专门治疗单元并不标准，患者常与其他重症患者安置在一起。本研究的目的是报告2015年入住肺部救援单元的成年患者的治疗结果，据我们所知，该单元是美国首个专门为需要VV ECMO的患者设立的重症监护病房。
收集了2015年1月1日至2015年12月31日期间入住肺部救援单元并接受VV ECMO治疗的所有患者的数据。记录了人口统计学信息、病史、体外膜肺氧合治疗前的数据、VV ECMO的适应症以及体外膜肺氧合治疗的持续时间、脱管生存率和出院生存率。在适当情况下报告均值（±标准差）和中位数（四分位间距[IQR]）。
共纳入49例患者。中位年龄为48岁（IQR，32 - 57）。插管前的中位氧合指数（PaO2/FIO2）为66（IQR，53 - 86）。插管前的中位机械通气天数为2天（IQR，1 - 4）。所有患者接受VV ECMO治疗的中位时间为311小时（IQR，203 - 461）。38例（78%）患者成功脱管，35例（71%）患者存活至出院。
VV ECMO在ARF/ARDS中的应用正在增加。我们已经证明，一个专门的多学科重症监护病房，由经过专门培训的医护人员提供标准化治疗，可以提高因ARF/ARDS需要VV ECMO治疗的患者的出院生存率。
治疗性研究，V级。
