Fleissner Felix, Mogaldea Alexandru, Martens Andreas, Natanov Ruslan, Rümke Stefan, Salman Jawad, Kaufeld Tim, Ius Fabio, Beckmann Erik, Haverich Axel, Kühn Christian
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.
J Cardiothorac Surg. 2021 Jun 2;16(1):158. doi: 10.1186/s13019-021-01508-9.
Extracorporeal life support (ECLS) is an established tool to stabilize severely ill patients with therapy-refractory hemodynamic or respiratory failure. Recently, we established a mobile ECLS retrieval service at our institution. However, data on the outcome of patients receiving ECLS at outside hospitals for transportation into tertiary hospitals is still sparse.
We have analyzed all patients receiving ECLS in outside hospitals (Transport group, TG) prior to transportation to our institution and compared the outcome to our in-house ECLS experience (Home Group, HG).
Between 2012 and 2018, we performed 978 ECLS implantations, 243 of which were performed on-site in tertiary hospitals for ECLS supported transportation. Significantly more veno-venous systems were implanted in TG (n = 129 (53%) vs. n = 327 (45%), p = 0.012). Indication for ECLS support differed between the groups, with more pneumonia; acute respiratory distress syndromes in the TG group and of course, more postcardiotomy patients in HG. Mean age was 47 (± 20) (HG) vs. 48 (± 18) (TG) years, p = 0.477 with no change over time. No differences were seen in ECLS support time (8.03 days ±8.19 days HG vs 7.81 days ±6.71 days TG, p = 0.675). 30-day mortality (n = 379 (52%) (HG) vs. n = 119 (49%) (TG) p = 0.265) and death on ECLS support (n = 322 (44%) (HG) vs. n = 97 (40%) TG, p = 0.162) were comparable between the two groups, despite a more severe SAVE score in the v-a TG (HG: - 1.56 (± 4.73) vs. TG -3.93 (± 4.22) p < 0.001). Mortality rates did not change significantly over the years. Multivariate risk analysis revealed Influenza, Peak Insp. Pressure at implantation, pO2/FiO2 ratio and ECLS Score (SAVE/RESP) as well as ECLS support time to be independent risk factors for mortality.
Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 h/7d ECLS standby for secondary and primary hospitals as a tertiary hospital. Increasing indications and total numbers for ECLS support raise the need for further studies to evaluate outcome in these patients.
体外生命支持（ECLS）是一种用于稳定患有难治性血流动力学或呼吸衰竭的重症患者的既定工具。最近，我们在本机构建立了一项移动ECLS转运服务。然而，关于在外院接受ECLS治疗后转运至三级医院的患者结局的数据仍然很少。
我们分析了所有在转运至本机构之前在外院接受ECLS治疗的患者（转运组，TG），并将结局与我们机构内部的ECLS经验（院内组，HG）进行比较。
在2012年至2018年期间，我们进行了978次ECLS植入，其中243次是在三级医院现场进行的，用于ECLS支持下的转运。TG组植入静脉-静脉系统的比例显著更高（n = 129（53%）对n = 327（45%），p = 0.012）。两组之间ECLS支持的适应症有所不同，TG组肺炎、急性呼吸窘迫综合征更多，当然，HG组心脏术后患者更多。平均年龄为47（±20）岁（HG）对48（±18）岁（TG），p = 0.477，且随时间无变化。ECLS支持时间无差异（HG组为8.03天±8.19天，TG组为7.81天±6.71天，p = 0.675）。30天死亡率（n = 379（52%）（HG）对n = 119（49%）（TG），p = 0.265）和在ECLS支持期间死亡（n = 322（44%）（HG）对n = 97（40%）TG，p = 0.162）在两组之间具有可比性，尽管在静脉-动脉TG组中SAVE评分更差（HG组：-1.56（±4.73）对TG组-3.93（±4.22），p < 0.001）。多年来死亡率没有显著变化。多因素风险分析显示流感、植入时的峰值吸气压力、pO2/FiO2比值和ECLS评分（SAVE/RESP）以及ECLS支持时间是死亡的独立危险因素。
移动ECLS支持是一项巨大挑战。然而，作为三级医院，为二级和一级医院提供每周7天、每天24小时的ECLS待命是合理的。ECLS支持的适应症增加和总数增加，需要进一步研究以评估这些患者的结局。
