Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
Intensive Crit Care Nurs. 2023 Apr;75:103350. doi: 10.1016/j.iccn.2022.103350. Epub 2022 Nov 10.
Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic.
DESIGN & SETTING: Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021.
One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549).
In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.
患有严重急性呼吸窘迫综合征的患者可能需要静脉-静脉体外膜肺氧合（V-V ECMO）支持。对于位于偏远医院的患者，由移动 ECMO 团队进行检索并转运至大容量中心与改善预后相关，包括最近的 COVID-19 大流行。为了能够安全转运患者，需要实施专门的 ECMO 检索计划。然而，关于如何安全有效地进行 ECMO 检索，证据仍然不足。我们报告了 COVID-19 大流行之前和期间，我们的 ECMO 中心进行的中心外 VV-ECMO 启动的单中心数据。
单中心回顾性研究。我们纳入了 2014 年 1 月 1 日至 2021 年 4 月 30 日期间，由我们的 ECMO 中心进行的所有检索任务。
在研究期间，共进行了 100 次 ECMO 任务，中位数检索量为每年 13（IQR：9-16）次任务。急性呼吸窘迫综合征的病因在 10 名患者（10%）中为 COVID-19。98（98%）名患者被检索并转运至我们的 ECMO 中心。为了确保安全转运，其中 91 名患者在现场进行置管并在 V-V ECMO 上转运。其余 7 名患者未进行 ECMO 集中化治疗，但他们均在 24 小时内连接到 V-V ECMO。患者转运过程中未发生并发症。ECMO 任务的中位数持续时间为 7 小时（IQR：6-9，范围：2-17）。ECMO 支持的中位数持续时间为 14 天（IQR：9-24），而 ICU 住院时间为 24 天（IQR：18-44）。总体而言，73 名患者在出院时存活（74%）。非 COVID-19 组和 COVID-19 组的生存率相似（73%比 80%，p=0.549）。
在这项单中心经验中，在 COVID-19 之前和期间，ECMO 患者的检索和地面运输是可行的，且与并发症无关。ECMO 检索计划的关键因素包括仔细选择运输救护车、培训专门的 ECMO 移动团队以及准备特定的检查表和标准操作程序。
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