Pediatric and Neonatal Intensive Care Unit, Armand Trousseau Hospital, APHP Sorbonne University, Paris, France.
Department of Economics, Carlos III University of Madrid, Madrid, Spain.
Pediatr Crit Care Med. 2020 Sep;21(9):e723-e730. doi: 10.1097/PCC.0000000000002421.
Extracorporeal membrane oxygenation is an established therapy for refractory cardiac and/or pulmonary failure that is not available in all centers. When infants and children require extracorporeal membrane oxygenation, they are sometimes placed on extracorporeal membrane oxygenation support in peripheral centers where extracorporeal membrane oxygenation is not available and then transferred on extracorporeal membrane oxygenation to specialized centers. The objective of this study is to first describe one of the largest cohorts of infants and children transported by a mobile unit while on extracorporeal membrane oxygenation.
We undertook a single-center retrospective study that included patients transported while on extracorporeal membrane oxygenation between November 1, 2014, and May 31, 2019.
All patients transported by our mobile extracorporeal membrane oxygenation unit during the study period were included. Computerized data collection was approved by the French Data Protection Authority (Commission nationale de l'informatique et des libertés n° 2121127V0).
Over the study period, our extracorporeal membrane oxygenation mobile team transported 80 patients on extracorporeal membrane oxygenation among which 20 were newborns (25%) and 60 were children of 1 month to 17 years old (75%); 57 patients were on venoarterial-extracorporeal membrane oxygenation (71%) and 23 on venovenous-extracorporeal membrane oxygenation (29%). The average duration of transport was 8.4 hours with a median of 8 hours; the average distance travelled was 189 ± 140 km. Transport was by air and then ground for 50% of the patients and by ground for 42%. We observed a significant decrease in the Vasoactive-Inotropic Score (125 vs 99; p = 0.005) and PaCO2 levels (67 vs 49 mm Hg; p = 0.0005) after arrival in our unit. Survival rate 6 months after PICU discharge was 46% (37). There was a statistically significant relationship between initial lactate level and mortality (p = 0.02). We observed minor adverse events in 39% of the transports and had no mortality during transport.
We describe one of the largest cohorts of infants and children transported by a mobile unit while on extracorporeal membrane oxygenation. Our findings confirm that it is safe to start extracorporeal membrane oxygenation in a referring center and to transport patients using an extracorporeal membrane oxygenation mobile team. The only risk factor associated with higher mortality was an initially elevated lactate level.
体外膜肺氧合是治疗难治性心肺衰竭的一种已确立的疗法，但并非所有中心都能提供。当婴儿和儿童需要体外膜肺氧合时，他们有时会在没有体外膜肺氧合的外围中心接受体外膜肺氧合支持，然后转至专门的中心接受体外膜肺氧合。本研究的目的首先是描述一组最大的在移动单元上进行体外膜肺氧合的婴儿和儿童的队列之一。
我们进行了一项单中心回顾性研究，纳入了 2014 年 11 月 1 日至 2019 年 5 月 31 日期间通过移动单元转运的患者。
在研究期间，通过我们的移动体外膜肺氧合单元转运的所有患者均包括在内。计算机数据采集得到了法国数据保护局（Commission nationale de l'informatique et des libertés n° 2121127V0）的批准。
在研究期间，我们的体外膜肺氧合移动团队转运了 80 名体外膜肺氧合患者，其中 20 名为新生儿（25%），60 名为 1 个月至 17 岁的儿童（75%）；57 名患者接受静脉-动脉体外膜肺氧合（71%），23 名患者接受静脉-静脉体外膜肺氧合（29%）。转运的平均持续时间为 8.4 小时，中位数为 8 小时；平均转运距离为 189±140km。50%的患者通过空运和地面运输，42%的患者通过地面运输。我们观察到到达我们单位后，血管活性-正性肌力评分（125 对 99；p = 0.005）和 PaCO2 水平（67 对 49mm Hg；p = 0.0005）显著降低。重症监护病房出院后 6 个月的生存率为 46%（37）。初始乳酸水平与死亡率之间存在统计学显著关系（p = 0.02）。在 39%的转运中观察到轻微的不良事件，在转运过程中没有死亡。
我们描述了一组最大的在移动单元上进行体外膜肺氧合的婴儿和儿童的队列之一。我们的研究结果证实，在转诊中心开始体外膜肺氧合并使用体外膜肺氧合移动团队转运患者是安全的。唯一与更高死亡率相关的危险因素是初始乳酸水平升高。
