体外膜氧合转运患者的疗效和风险因素:ECMO 中心的经验

Lingjuan Liu , Dingji Hu , Tong Hao , Shanshan Chen , Lei Chen , Yike Zhu , Chenhui Jin , Jing Wu , Haoya Fu , Haibo Qiu , Yi Yang , Songqiao Liu
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引用次数: 0

摘要

体外膜氧合(ECMO)已被证明是一种支持心肺衰竭患者的方法和技术。然而,考虑到高风险的技术操作和涉及的患者护理问题,在ECMO支持下运送患者是具有挑战性的。在此,我们研究了重症患者转运过程中ECMO的安全性及其对死亡率的影响,以期在临床实践中提供更安全有效的转运策略。方法为了评估ECMO患者运输的安全性,本研究对2017年至2023年在重症监护病房(ICU)中心需要ECMO支持和运输的危重成人患者进行回顾性分析。本研究采用标准ECMO转运方案,并对收集到的临床数据和转运过程进行了全面的统计分析。采用Kaplan-Meier分析确定ECMO患者的28天生存率,同时采用logistic回归确定预后因素。结果303例ECMO患者中,111例(36.6%)被转移。转运组69.4%为男性,平均年龄(42.0±17.0)岁,平均体重指数(24.4±4.6)kg/m2,静脉-动脉- ecmo占52.5%。运输距离中位数为190 km(四分位间距[IQR]: 70-260),最长运输距离为8100 km。中位运输时间为180 (IQR: 100-260) min,最长时间为1720 min。运输过程中未发生包括死亡或机械故障在内的严重不良事件。整个队列28天生存率为64.7% (n=196), ICU生存率为56.1% (n=170);转运组28天生存率为72.1% (n=80), ICU生存率为66.7% (n=74)。倾向评分匹配后,两组28天生存率无显著差异(P=0.56)。此外,我们发现急性生理和慢性健康评估II评分(优势比[OR]=1.06, P <0.01)、乳酸水平(>5 mmol/L, OR=2.80, P=0.01)和肾脏替代治疗开始(OR=3.03, P <0.01)与死亡风险增加相关。结论:在不同医疗机构之间进行ECMO患者的转运是一种安全的操作,如果由熟练的转运团队精心安排和执行,不会增加患者的死亡率。这些患者的预后主要受其先前存在的医疗状况或在ECMO治疗过程中可能出现的并发症的影响。这些结果构成了在医疗保健区域内创建专门ECMO网络中心的基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes and risk factors of transported patients with extracorporeal membrane oxygenation: An ECMO center experience

Background

Extracorporeal membrane oxygenation (ECMO) has been proven to be a support method and technology for patients with cardiopulmonary failure. However, the transport of patients under ECMO support is challenging given the high-risk technical maneuvers and patient-care concerns involved. Herein, we examined the safety of ECMO during the transport of critically ill patients and its impact on mortality rates, to provide more secure and effective transport strategies in clinical practice.

Method

To assess the safety of ECMO patient transport, this study conducted a retrospective analysis on critically ill adults who required ECMO support and transport at the intensive care unit (ICU) center between 2017 and 2023. The study utilized standard ECMO transport protocols and conducted a comprehensive statistical analysis of the collected clinical data and transport processes. The 28-day survival rate for ECMO patients was determined using Kaplan–Meier analysis, while logistic regression identified prognostic factors.

Result

Out of 303 patients supported with ECMO, 111 (36.6%) were transported. 69.4% of the transport group were male, mean age was (42.0±17.0) years, mean body mass index was (24.4±4.6) kg/m2, and veno-arterial-ECMO accounted for 52.5%. The median transportation distance was 190 (interquartile range [IQR]: 70–260) km, and the longest distance was 8100 km. The median transit time was 180 (IQR: 100–260) min, and the maximum duration was 1720 min. No severe adverse events including death or mechanical failure occurred during transportation. The 28-day survival rate was 64.7% (n=196) and ICU survival rate was 56.1% (n=170) for the entire cohort; whereas, the 28-day survival rate was 72.1% (n=80) and ICU survival rate was 66.7% (n=74) in the transport group. A non-significant difference in 28-day survival was observed between the two groups after propensity score matching (P=0.56). Additionally, we found that acute physiology and chronic health evaluation II score (odds ratio [OR]=1.06, P <0.01), lactate levels (>5 mmol/L, OR=2.80, P=0.01), and renal replacement therapy initiation (OR=3.03, P <0.01) were associated with increased mortality risk.

Conclusion

Transporting patients on ECMO between medical facilities is a safe procedure that does not increase patient mortality rates, provided it is orchestrated and executed by proficient transport teams. The prognostic outcome for these patients is predominantly influenced by their pre-existing medical conditions or by complications that may develop during the course of ECMO therapy. These results form the basis for the creation of specialized ECMO network hubs within healthcare regions.
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来源期刊
Journal of intensive medicine
Journal of intensive medicine Critical Care and Intensive Care Medicine
CiteScore
1.90
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