Schmiady Martin O, Hofmann Michael, Sromicki Juri, Halbe Maximilian, van Tilburg Koen, Aser Raed, Mestres Carlos A, Maisano Francesco, Ferrari Enrico
Division of Cardiac Surgery, University Heart Center, University Hospital of Zurich, Zurich, Switzerland.
Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):812-816. doi: 10.1093/icvts/ivaa326.
Extracorporeal membrane oxygenation (ECMO) is a resource-intensive, highly specialized and expensive therapy that is often reserved for high-volume centres. In recent years, we established an inter-hospital ECMO transfer programme that enables ECMO implants in peripheral hospitals. During the pandemic, the programme was expanded to include ECMO support in selected critically ill patients with coronavirus disease 2019 (COVID-19).
This retrospective single-centre study reports the technical details and challenges encountered during our initial experience with ECMO implants in peripheral hospitals for patients with COVID-19.
During March and April 2020, our team at the University Hospital of Zurich performed 3 out-of-centre ECMO implants at different peripheral hospitals. The implants were performed without any complications. The patients were transported by ambulance or helicopter. Good preparation and selection of the required supplies are the keys to success. The implant should be performed by a well-trained, seasoned ECMO team, because options are limited in most peripheral hospitals.
Out-of-centre ECMO implants in well-selected patients with COVID-19 is feasible and safe if a well-established organization is available and if the implantation is done by an experienced and regularly trained team.
体外膜肺氧合（ECMO）是一种资源密集型、高度专业化且昂贵的治疗方法，通常仅在大型中心使用。近年来，我们建立了一项院际ECMO转运计划，使外周医院能够开展ECMO植入。在大流行期间，该计划扩大到包括为部分患有2019冠状病毒病（COVID-19）的重症患者提供ECMO支持。
这项回顾性单中心研究报告了我们在外周医院为COVID-19患者首次进行ECMO植入时遇到的技术细节和挑战。
在2020年3月和4月期间，我们苏黎世大学医院的团队在不同的外周医院进行了3次院外ECMO植入。植入过程没有出现任何并发症。患者通过救护车或直升机转运。充分准备和选择所需用品是成功的关键。植入应由训练有素、经验丰富的ECMO团队进行，因为大多数外周医院的选择有限。
如果有完善的组织架构，并且由经验丰富且定期接受培训的团队进行植入，那么为精心挑选的COVID-19患者进行院外ECMO植入是可行且安全的。
