Mihama Toru, Liem Spencer, Cavarocchi Nicholas, Hirose Hitoshi
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Perfusion. 2020 Oct;35(7):633-640. doi: 10.1177/0267659119897784. Epub 2020 Jan 17.
Extracorporeal membrane oxygenation is an accepted therapy option for refractory cardiac or respiratory failure. The outcomes of cases initiated at non-extracorporeal membrane oxygenation centers and subsequently transported for management to an extracorporeal membrane oxygenation center require further investigation.
Retrospective institutional review board-approved database research and chart reviews were performed on referrals for extracorporeal membrane oxygenation initially admitted to an outside non-extracorporeal membrane oxygenation center hospital (OSH) then transferred to our extracorporeal membrane oxygenation center (Thomas Jefferson University Hospital (TJUH)). Unstable patients were placed on extracorporeal membrane oxygenation at OSH (Group A) before transport, while others were initiated at our certified extracorporeal membrane oxygenation center (Group B) upon arrival. Group A was further subdivided into patients cannulated by OSH personnel (Group A) or TJUH transport team (Group A). Outcomes and complications were compared between the different initiation sites and personnel.
A total of 108 patients were transferred from August 2010 to June 2018. The technical complication rate for all Group A patients was 33/49 (67%), while that of Group B was 24/59 (41%); p = 0.006. Within Group A, Group A had a greater technical complication rate with 29/33 (88%) than Group A with 4/16 (25%); p < 0.001. extracorporeal membrane oxygenation survival rate was 34/49 (69%) in Group A and 43/59 (73%) in Group B; p = 0.690. The extracorporeal membrane oxygenation survival rate for Group A and Group A was 21/33 (64%) and 13/16 (81%), respectively; p = 0.210.
Promising extracorporeal membrane oxygenation survival rates were observed in transferred patients. The complication rates related to cannulation technique were significantly higher when patients were initiated at non-extracorporeal membrane oxygenation centers, especially when placed by personnel from non-extracorporeal membrane oxygenation centers.
体外膜肺氧合是治疗难治性心脏或呼吸衰竭的一种公认的治疗选择。在非体外膜肺氧合中心开始治疗并随后转运至体外膜肺氧合中心进行管理的病例的治疗结果需要进一步研究。
对最初入住外部非体外膜肺氧合中心医院（OSH）然后转至我们的体外膜肺氧合中心（托马斯·杰斐逊大学医院（TJUH））的体外膜肺氧合转诊病例进行了回顾性机构审查委员会批准的数据库研究和病历审查。不稳定患者在转运前于OSH接受体外膜肺氧合治疗（A组），而其他患者在抵达后于我们经认证的体外膜肺氧合中心开始治疗（B组）。A组进一步细分为由OSH人员插管的患者（A组）或TJUH转运团队插管的患者（A组）。比较了不同起始地点和人员之间的治疗结果和并发症。
2010年8月至2018年6月期间共转诊108例患者。所有A组患者的技术并发症发生率为33/49（67%），而B组为24/59（41%）；p = 0.006。在A组中，A组的技术并发症发生率更高，为29/33（88%），而A组为4/16（25%）；p < 0.001。A组的体外膜肺氧合生存率为34/49（69%），B组为43/59（73%）；p = 0.690。A组和A组的体外膜肺氧合生存率分别为21/33（64%）和13/16（81%）；p = 0.210。
转运患者的体外膜肺氧合生存率可观。当患者在非体外膜肺氧合中心开始治疗时，尤其是由非体外膜肺氧合中心的人员进行插管时，与插管技术相关的并发症发生率显著更高。
