From the Division of Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
ASAIO J. 2020 Sep/Oct;66(9):1036-1041. doi: 10.1097/MAT.0000000000001110.
The shortage of dedicated pediatric extracorporeal membrane oxygenation (ECMO) centers and the expanding indications for pediatric ECMO necessitate a regional program for transport of ECMO-supported patients. Data about feasibly and safety of pediatric ECMO transport are scarce. Our aim is to describe our experience with a pediatric ECMO reach-out program and review pertinent literature. Demographic, clinical, and outcome data were collected retrospectively from the charts of all patients cannulated onto ECMO at referring centers and transported to our center from 2003 to 2018. Similar data were recorded for patients who were referred for ECMO support from within the hospital. The cohort included 80 patients cannulated at 17 referring centers. The transport team included a senior pediatric cardiac surgeon and an ECMO specialist. All transfers but one were done by special emergency medical service ambulance. No major complications or deaths occurred during transport, and all patients were stable upon arrival to our unit. Mortality was lower in the ECMO reach-out cohort than in-house patients referred for ECMO support. This is the first study from Israel and one of the largest to date describing a dedicated pediatric ECMO transport program. Extracorporeal membrane oxygenation transport appears to be feasible and safe when conducted by a small, highly skilled mobile team. Successful reach-out program requires open communication between the referring physician and the accepting center. As survival correlates with ECMO volume, maintaining a large ECMO center with 24/7 retrieval capabilities may be the best strategy for pediatric mechanical circulatory support program.
专门的儿科体外膜肺氧合 (ECMO) 中心短缺，以及儿科 ECMO 的适应证不断扩大，这使得需要建立一个 ECMO 支持患者的区域转运计划。关于儿科 ECMO 转运的可行性和安全性的数据很少。我们的目的是描述我们的儿科 ECMO 外展计划的经验，并回顾相关文献。从 2003 年至 2018 年，我们从转诊中心的所有接受 ECMO 插管的患者图表中回顾性地收集了人口统计学、临床和结局数据，并转运至我们中心。对于从医院内转来接受 ECMO 支持的患者，也记录了类似的数据。该队列包括在 17 个转诊中心插管的 80 名患者。转运团队包括一名资深儿科心脏外科医生和一名 ECMO 专家。除了一次，所有转运都由专门的紧急医疗服务救护车进行。转运过程中没有发生重大并发症或死亡，所有患者到达我们科室时都稳定。外展 ECMO 组的死亡率低于因 ECMO 支持而转来的院内患者。这是以色列的第一项研究，也是迄今为止描述专门的儿科 ECMO 转运计划的最大研究之一。由一个小型、高度熟练的移动团队进行的体外膜肺氧合转运似乎是可行且安全的。成功的外展计划需要转诊医生和接收中心之间的开放沟通。由于存活率与 ECMO 量相关，因此维持一个具有 24/7 检索能力的大型 ECMO 中心可能是儿科机械循环支持计划的最佳策略。
