Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234.
US Army Special Operations Command, Bldg X4047 New Dawn Drive, Fort Bragg, NC 78234.
Mil Med. 2020 Dec 30;185(11-12):e2055-e2060. doi: 10.1093/milmed/usaa215.
The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients.
We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth.
The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%.
Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.
在过去十年中，体外膜肺氧合（ECMO）在危重症成年患者的治疗中得到了广泛应用。它已被用于更严峻的环境中，包括战场上的伤员。美国军方于 2005 年成立了急性肺救援小组，以转运和治疗无法通过标准医疗后送资源治疗的患者。2012 年，美国军方扩大了这一能力，在布洛克陆军医疗中心建立了 ECMO 项目。为了保持最新状态，该项目治疗军事和民用患者。
我们对 2012 年 9 月至 2019 年 12 月期间，由美国唯一的 ECMO 项目转运的所有患者进行了单中心回顾性研究。我们分析了基本人口统计学数据、ECMO 适应证、转运距离范围、脱机和出院存活率以及项目发展。
美国军方 ECMO 小组进行了 110 次 ECMO 转运。其中，88 名患者（80%）被转运到我们的机构，81 名患者（73.6%）在转运前由我们的团队进行 ECMO 置管。ECMO 的主要适应证是呼吸衰竭（76%）。转运距离范围为 6.5 至 8451 英里（中位数空运距离=1328 英里，中位数地面转运距离=16 英里）。在远程置管的患者中，脱机存活率为 76%，出院存活率为 73.3%。
自 2017 年 1 月以来，美国军方 ECMO 小组的使用呈指数级增长。随着转运业务节奏的加快和重症监护转运距离的增加，脱机和出院存活率超过了 ELSO 公布数据中描述的国家基准。在远程地点为患者置管并将重症监护转运到军事医疗设施的能力使美国军方能够维持关键医疗资产的战备状态。
