Gawda Ryszard, Piwoda Maciej, Marszalski Maciej, Lyp Katarzyna, Piwoda Jolanta, Maj Magdalena, Gawor Maciej, Molsa Maciej, Pietka Marek, Czarnik Tomasz
Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, 45-401 Opole, Poland.
Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, 45-052 Opole, Poland.
Healthcare (Basel). 2022 Feb 22;10(3):414. doi: 10.3390/healthcare10030414.
A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU).
A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center's activity, from mid 2018 to the end of 2020.
An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO.
A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach.
拥有多学科团队的高容量中心被视为提供体外膜肺氧合（ECMO）的最佳场所。我们假设，在中型综合重症监护病房（ICU）中，重症医学专家也可以成功创建并随后完全发展一个ECMO中心。
在一家三级医院现有的综合ICU结构内创建了一个建立新的ECMO转诊中心的模型。对该中心2018年年中至2020年底活动初期治疗的前33例患者进行了回顾性分析。
一个ECMO中心完全基于现有综合ICU的资源建立并发展起来。共治疗了33例患者。他们90天的总体生存率为60.6%。在静脉-静脉（VV）模式下，ECMO持续时间、ICU住院时间和序贯器官衰竭评估（SOFA）评分显著高于静脉-动脉模式。接受VV-ECMO治疗的幸存者和非幸存者在临床特征上未观察到显著差异。
可以将区域ECMO中心作为三级医院综合ICU的一个组成部分来设立。体外治疗，如连续性肾脏替代治疗和机械通气，可完全由重症医学专家管理。需要进一步的研究来表明，基于ICU设立新的ECMO中心的方法与多学科方法同样有效。
