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加拿大西部儿科体外生命支持转运:14 年以上的经验。

Pediatric Extracorporeal Life Support Transport in Western Canada: Experience over 14 years.

机构信息

From the Department of Pediatrics and Adolescent Medicine, Paediatric Intensive Care Unit, Hong Kong Children's Hospital, Hong Kong.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

出版信息

ASAIO J. 2022 Sep 1;68(9):1165-1173. doi: 10.1097/MAT.0000000000001609. Epub 2021 Dec 8.

Abstract

This retrospective cohort study describes all children transported on extracorporeal life support (ECLS) by the Stollery Children's Hospital Pediatric Transport team (SCH-PTT) between 2004 and 2018. We compared outcomes and complications between primary (SCH-PTT performed ECLS cannulation) vs. secondary (cannulation performed by referring facility) transports, as well as secondary transports from referring centers with and without an established ECLS cannulation program. SCH-PTT performed 68 ECLS transports during the study period. Median (IQR) transport distance was 298 (298-1,068) kilometers. Mean (SD) times from referral call to ECLS-initiation were: primary transports 7.8 (2.9) vs. 2.5(3.5) hours for secondary transports, p value < 0.001. Complications were common (n = 65, 95%) but solved without leading to adverse outcomes. There were no significant differences in the number of complications between primary and secondary transports. There was no significant difference in survival to ECLS decannulation between primary 9 (90%) and secondary transports 43 (74%), p value = 0.275. ECLS survival was higher for children cannulated by the SCH-PTT or a center with an ECLS cannulation program: 42 (82%) vs. 10 (59%), p value = 0.048. Critically ill children on ECLS can be safely transported by a specialized pediatric ECLS transport team. Secondary transports from a center with an ECLS cannulation program are also safe and have similar results as primary transports.

摘要

这项回顾性队列研究描述了 2004 年至 2018 年间,由斯特罗利儿童医院儿科转运团队(SCH-PTT)转运的所有接受体外生命支持(ECLS)的儿童。我们比较了主要(SCH-PTT 进行 ECLS 插管)与次要(转介机构进行插管)转运之间的结局和并发症,以及来自有和没有建立 ECLS 插管计划的转介中心的次要转运之间的结局和并发症。SCH-PTT 在研究期间进行了 68 次 ECLS 转运。中位数(IQR)转运距离为 298(298-1068)公里。从转介电话到 ECLS 开始的平均(SD)时间分别为:主要转运为 7.8(2.9)小时,次要转运为 2.5(3.5)小时,p 值<0.001。并发症很常见(n=65,95%),但无需导致不良结局即可解决。主要转运和次要转运之间的并发症数量无显著差异。主要转运的 9 名(90%)和次要转运的 43 名(74%)儿童成功撤机并存活至 ECLS 拔管,差异无统计学意义,p 值=0.275。SCH-PTT 或有 ECLS 插管计划的中心进行插管的儿童 ECLS 存活率更高:42(82%)比 10(59%),p 值=0.048。接受 ECLS 治疗的危重症儿童可以由专门的儿科 ECLS 转运团队安全转运。来自有 ECLS 插管计划的中心的次要转运也是安全的,并且与主要转运结果相似。

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