Emergency Department, Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Emergency Department, Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Cardiothorac Vasc Anesth. 2018 Jun;32(3):1142-1150. doi: 10.1053/j.jvca.2017.06.018. Epub 2017 Jun 8.
Many extracorporeal membrane oxygenation (ECMO) centers for respiratory failure and ECMO mobile teams were instituted during the H1N1 pandemic. Data on transportation are scarce and heterogeneous. The authors therefore described the experience of their referral ECMO center for severe respiratory failure from 2009 to 2016 and gave a comprehensive report of transfers performed by their mobile ECMO team.
Observational retrospective study.
An intensive care unit (ECMO referral center) in a teaching hospital.
One hundred and sixty consecutive patients with acute respiratory distress syndrome refractory to conventional treatment requiring veno-venous (VV)-ECMO.
VV-ECMO implantation.
In this series, the transferred patients on ECMO averaged 57%, with annual percentages ranging from 28% to 90% over the years. No adverse event was observed during transportation. A progressive increase in simplified acute physiology score (SAPS) values and in the use of norepinephrine were detectable (p = 0.048 and p = 0.037, respectively) as well as in neuromuscular blockers use (p = 0.004). Dual-lumen cannule were more frequently used in recent years (p < 0.001). The overall mortality rate was 40% (64/160), with no differences over the years or between transferred and local patients. Body mass index and pre-ECMO neuromuscular blockers and SAPS were independent predictors for early mortality (when adjusted for age).
The workload of the authors' referral center and mobile team did not change, documenting that severe respiratory failure requiring VV-ECMO support is still a clinical need. No difference in mortality rate was detectable during this period or between transferred and local patients who were managed by the same team.
在 H1N1 大流行期间，许多体外膜肺氧合（ECMO）中心和 ECMO 移动团队都建立起来了。关于转运的数据很少且存在异质性。因此，作者描述了其转诊 ECMO 中心在 2009 年至 2016 年期间对严重呼吸衰竭患者的治疗经验，并全面报告了其移动 ECMO 团队进行的转运情况。
观察性回顾性研究。
教学医院的重症监护病房（ECMO 转诊中心）。
160 例急性呼吸窘迫综合征患者，对常规治疗无效，需要静脉-静脉（VV）-ECMO 治疗。
VV-ECMO 植入。
在本系列中，转运至 ECMO 的患者平均占 57%，每年的百分比从 28%到 90%不等。在转运过程中没有观察到不良事件。可以检测到简化急性生理学评分（SAPS）值和去甲肾上腺素的使用逐渐增加（p = 0.048 和 p = 0.037），以及神经肌肉阻滞剂的使用（p = 0.004）。近年来，双腔插管的使用更为频繁（p < 0.001）。总死亡率为 40%（64/160），不同年份或转运患者与本地患者之间无差异。体重指数、ECMO 前神经肌肉阻滞剂和 SAPS 是早期死亡率的独立预测因素（在调整年龄后）。
作者的转诊中心和移动团队的工作量没有变化，这表明需要 VV-ECMO 支持的严重呼吸衰竭仍然是一种临床需求。在此期间或在由同一团队管理的转运患者和本地患者之间，未检测到死亡率的差异。
