危重患者在体外膜肺氧合支持下院间转运的病例系列报道
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摘要
目的总结我院体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)团队对10例外院危重患者实施ECMO支持下院间转运的临床结果和经验。方法收集2016年6月至2018年1月我院ECMO团队对10例外院危重患者实施ECMO支持下院间转运的临床资料,对患者的转运距离、转运并发症及治疗结果进行总结。结果 10例ECMO患者的转运距离为3. 4～248. 0 km,平均72. 6 km。转运过程中1例静脉-静脉(V-V) ECMO患者静脉管道扭曲,影响ECMO流量;2例静脉-动脉(V-A)ECMO患者切口渗血。10例患者都安全到达我院。1例患者治愈出院;1例患者成功撤除ECMO,后因肺部感染、多器官功能衰竭死亡;1例患者死亡;2例患者家属最后放弃治疗,自动出院;另外5例供体均成功获取肝脏和(或)肾脏。结论在ECMO支持下院间转运危重患者可以安全地进行,并发症可控;相关人员应重视ECMO多学科团队建设并规范操作流程。
Objective To summerize the clinical outcomes and experience of extracorporeal membrane oxygenation(ECMO)-supported inter-hospital transport for critically ill patients. Methods Clinical data of 10 critically ill patients undergoing ECMO-supported inter-hospital transport by our ECMO team during June 2016 and January 2018 were collected in this study. The transport distance,transport complications and treatment outcomes were summarized. Results The transport distance of 10 cases was 3. 4to 248. 0 km,at an average of 72. 6 km. During the transportation,1 case of V-V ECMO patients(drainage from the right femoral vein and reflux to the right internal jugular vein) had twist of venous tubes,which affected ECMO flow,and 2 cases of V-A ECMO patients(drainage from the right femoral vein and reflux to the right femoral artery) had incision bleeding. All of the 10 cases safely reached our hospital. One patient was cured and discharged,1 was successfully removed from ECMO but died of pulmonary infection and multiple organ failure,1 patient died,2 patients discharged from hospital by themselves because their family finally gave up the treatment,and the left 5 patients became brain death donors for the liver and/or kidneys.Conclusion Inter-hospital transport on ECMO can be safely performed in critically ill patients,and the complications associated with ECMO transport can be controlled. The staffs involved should pay attention to the construction of ECMO multidisciplinary team and standardize the operating procedures.
Objective To summerize the clinical outcomes and experience of extracorporeal membrane oxygenation(ECMO)-supported inter-hospital transport for critically ill patients. Methods Clinical data of 10 critically ill patients undergoing ECMO-supported inter-hospital transport by our ECMO team during June 2016 and January 2018 were collected in this study. The transport distance,transport complications and treatment outcomes were summarized. Results The transport distance of 10 cases was 3. 4to 248. 0 km,at an average of 72. 6 km. During the transportation,1 case of V-V ECMO patients(drainage from the right femoral vein and reflux to the right internal jugular vein) had twist of venous tubes,which affected ECMO flow,and 2 cases of V-A ECMO patients(drainage from the right femoral vein and reflux to the right femoral artery) had incision bleeding. All of the 10 cases safely reached our hospital. One patient was cured and discharged,1 was successfully removed from ECMO but died of pulmonary infection and multiple organ failure,1 patient died,2 patients discharged from hospital by themselves because their family finally gave up the treatment,and the left 5 patients became brain death donors for the liver and/or kidneys.Conclusion Inter-hospital transport on ECMO can be safely performed in critically ill patients,and the complications associated with ECMO transport can be controlled. The staffs involved should pay attention to the construction of ECMO multidisciplinary team and standardize the operating procedures.
引文
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[12]朱世超,李黎明,邵换璋,等. 1例接受ECMO治疗的暴发性心肌炎患者院间转运的管理[J].河南医学研究,2017,26(23):4278-4279. DOI:10. 3969/j. issn. 1004-437X. 2017. 23. 025.ZHU S C,LI L M,SHAO H Z,et al. Management of interhospital transport in 1 patients with fulminant myocarditis receiving ECMO treatment[J]. Henan Med Res,2017,26(23):4278-4279. DOI:10. 3969/j. issn. 1004-437X.2017. 23. 025.
[13]潘红,黄琴红,蔡英华,等. 13例体外膜肺氧合治疗危重患者院内转运的护理[J].中华护理杂志,2017,52(5):561-563. DOI:10. 3761/j. issn. 0254-1769. 2017.05. 011.PAN H,HUANG Q H,CAI Y H,et al. Nursing care of 13critically ill patients with extracorporeal membrane oxygenation for intra-hospital transfer[J]. Chin J Nurs,2017,52(5):561-563. DOI:10. 3761/j. issn. 0254-1769. 2017.05. 011.
[14]龙村.体外膜肺氧合循环支持专家共识[J].中国体外循环杂志,2014,12(2):65-67. DOI:10. 13498/j. cnki.chin. j. ecc. 2014. 02. 01.LONG C. Expert consensus on extracorporeal membrane oxygenation for circulatory support[J]. Chin J Extracorporeal Circ,2014,12(2):65-67. DOI:10. 13498/j. cnki. chin.j. ecc. 2014. 02. 01.
[15] BROMAN L M,HOLZGRAEFE B,PALMER K,et al. The Stockholm experience:interhospital transports on extracorporeal membrane oxygenation[J]. Critical Care,2015,19:278. DOI:10. 1186/s13054-015-0994-6.
[16] FRIED M J,BRUCE J,COLQUHOUN R,et al. Interhospital transfers of acutely ill adults in Scotland[J]. Anaesthesia,2010,65(2):136-144. DOI:10. 1111/j.1365-2044. 2009. 06165. x.
[17] BECKMANN U,GILLIES D M,BERENHOLTZ S M,et al.Incidents relating to the intra-hospital transfer of critically ill patients[J]. Intensive Care Med,2004,30(8):1579-1585. DOI:10. 1007/s00134-004-2177-9.
[18] KUE R,BROWN P,NESS C,et al. Adverse clinical events during intrahospital transport by a specialized team:a preliminary report[J]. Am J Crit Care,2011,20(2):153-161. DOI:10. 4037/ajcc2011478.
[19] HSIEH C E,LIN H C,TSUI Y C,et al. Extracorporeal membrane oxygenation support in potential organ donors for brain death determination[J]. Transplant Proc,2011,43(7):2495-2498. DOI:10. 1016/j. transproceed. 2011.06. 027.
[20] BARROU B,BILLAULT C,NICOLAS-ROBIN A. The use of extra-corporeal membranous oxygenation in donors after cardiac death[J]. Curr Opin Organ Transplant,2013,18(2):148-153. DOI:10. 1097/MOT. 0b013e32835e29f5.
[21] JIMENEZ-GALANES S, MENEU-DIAZ M J, ELOLAOLASO A M,et al. Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation[J]. Liver Transpl,2009,15(9):1110-1118. DOI:10. 1002/lt. 21867.
[22] CARTER T,BODZIN A S,HIROSE H,et al. Outcome of organs procured from donors on extracorporeal membrane oxygenation support:an analysis of kidney and liver allograft data[J]. Clin Transplant,2014,28(7):816-820. DOI:10. 1111/ctr. 12384.
[2]龙村.体外膜肺氧合的临床应用现状和发展趋势[J].内科急危重症杂志,2013,19(3):132-134. DOI:10.11768/nkjwzzzz20130302.LONG C. The clinical application of extracorporeal membrane oxygenation and its development trend[J]. J Intern Intens Med,2013,19(3):132-134. DOI:10. 11768/nkjwzzzz20130302.
[3]章晓华,庄建.中国体外膜肺氧合技术开展的现状及思考[J].中国体外循环杂志,2017,15(2):68-71. DOI:10.13498/j. cnki. chin. j. ecc. 2017. 02. 02.ZHANG X H,ZHUANG J. Current situation and thinking of extracorporeal membrane oxygenation technology in China[J]. Chin J Extracorporeal Circulation,2017,15(2):68-71. DOI:10. 13498/j. cnki. chin. j. ecc. 2017. 02. 02.
[4] DROOGH J M,SMIT M,ABSALOM A R,et al. Transferring the critically ill patient:are we there yet?[J]. Crit Care,2015,19(1):1-7. DOI:10. 1186/s13054-015-0749-4.
[5] BLAKEMAN T C,BRANSON R D. Inter-and intra-hospital transport of the critically ill[J]. Respir Care,2013,58(6):1008-1021. DOI:10. 4187/respcare. 02404.
[6] PRODHAN P,FISER R T,CENAC S,et al. Intrahospital transport of children off extracorporeal membrane oxygenation:indications,process,inter-ventions,and effectiveness[J].Pediatr Crit Care Med,2010,11(2):227-233. DOI:10.1097/PCC. 0b013e3181b063b2.
[7] LEE S G,SON B S,KANG P J,et al. The feasibility of extracorporeal membrane oxygenation support for inter-hospital transport and as a bridge to lung transplantation[J]. Ann Thorac Cardiovasc Surg,2014,20(1):26-31. DOI:10.5761/atcs. oa. 13-00203.
[8] BRYNER B,COOLEY E,COPENHAVER W,et al. Twodecades’experience with interfacility transport on extracorporeal membrane oxygenation[J]. Ann Thorac Surg,2014,98(4):1363-1370. DOI:10. 1016/j. athoracsur. 2014. 06. 025.
[9] COPPOLA C P,TYREE M,LARRY K,et al. A22-year experience in global transport extracorporeal membrane oxygenation[J]. J Pediatr Surg,2008,43(1):46-52. DOI:10.1016/j. jpedsurg. 2007. 09. 021.
[10]朱文亮,代荣钦,王海波,等. ECMO支持下在危重患者长途院际转运的案例报道及文献复习[J].河南医学研究,2017,26(22):4086-4089. DOI:10. 3969/j. issn.1004-437X. 2017. 22. 025.ZHU W L,DAI R Q,WANG H B,et al. ECMO support in critically ill patients for long distance inter-hospital transport:a case report and literature review[J]. Henan Med Res,2017,26(22):4086-4089. DOI:10. 3969/j. issn.1004-437X. 2017. 22. 025.
[11]郑茹娜,潘利飞,陈琨,等. ECMO团队合作在基层医院危重病人抢救和转运中的应用[J].中国护理管理,2016,16(5):646-649. DOI:10. 3969/j. issn. 1672-1756. 2016. 05. 018.ZHENG R N,PAN L F,CHEN K,et al. ECMO teamwork for the resuscitation and transportation of critically ill patients in rural hospitals[J]. Chin Nurs Management,2016,16(5):646-649. DOI:10. 3969/j. issn. 1672-1756. 2016.05. 018.
[12]朱世超,李黎明,邵换璋,等. 1例接受ECMO治疗的暴发性心肌炎患者院间转运的管理[J].河南医学研究,2017,26(23):4278-4279. DOI:10. 3969/j. issn. 1004-437X. 2017. 23. 025.ZHU S C,LI L M,SHAO H Z,et al. Management of interhospital transport in 1 patients with fulminant myocarditis receiving ECMO treatment[J]. Henan Med Res,2017,26(23):4278-4279. DOI:10. 3969/j. issn. 1004-437X.2017. 23. 025.
[13]潘红,黄琴红,蔡英华,等. 13例体外膜肺氧合治疗危重患者院内转运的护理[J].中华护理杂志,2017,52(5):561-563. DOI:10. 3761/j. issn. 0254-1769. 2017.05. 011.PAN H,HUANG Q H,CAI Y H,et al. Nursing care of 13critically ill patients with extracorporeal membrane oxygenation for intra-hospital transfer[J]. Chin J Nurs,2017,52(5):561-563. DOI:10. 3761/j. issn. 0254-1769. 2017.05. 011.
[14]龙村.体外膜肺氧合循环支持专家共识[J].中国体外循环杂志,2014,12(2):65-67. DOI:10. 13498/j. cnki.chin. j. ecc. 2014. 02. 01.LONG C. Expert consensus on extracorporeal membrane oxygenation for circulatory support[J]. Chin J Extracorporeal Circ,2014,12(2):65-67. DOI:10. 13498/j. cnki. chin.j. ecc. 2014. 02. 01.
[15] BROMAN L M,HOLZGRAEFE B,PALMER K,et al. The Stockholm experience:interhospital transports on extracorporeal membrane oxygenation[J]. Critical Care,2015,19:278. DOI:10. 1186/s13054-015-0994-6.
[16] FRIED M J,BRUCE J,COLQUHOUN R,et al. Interhospital transfers of acutely ill adults in Scotland[J]. Anaesthesia,2010,65(2):136-144. DOI:10. 1111/j.1365-2044. 2009. 06165. x.
[17] BECKMANN U,GILLIES D M,BERENHOLTZ S M,et al.Incidents relating to the intra-hospital transfer of critically ill patients[J]. Intensive Care Med,2004,30(8):1579-1585. DOI:10. 1007/s00134-004-2177-9.
[18] KUE R,BROWN P,NESS C,et al. Adverse clinical events during intrahospital transport by a specialized team:a preliminary report[J]. Am J Crit Care,2011,20(2):153-161. DOI:10. 4037/ajcc2011478.
[19] HSIEH C E,LIN H C,TSUI Y C,et al. Extracorporeal membrane oxygenation support in potential organ donors for brain death determination[J]. Transplant Proc,2011,43(7):2495-2498. DOI:10. 1016/j. transproceed. 2011.06. 027.
[20] BARROU B,BILLAULT C,NICOLAS-ROBIN A. The use of extra-corporeal membranous oxygenation in donors after cardiac death[J]. Curr Opin Organ Transplant,2013,18(2):148-153. DOI:10. 1097/MOT. 0b013e32835e29f5.
[21] JIMENEZ-GALANES S, MENEU-DIAZ M J, ELOLAOLASO A M,et al. Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation[J]. Liver Transpl,2009,15(9):1110-1118. DOI:10. 1002/lt. 21867.
[22] CARTER T,BODZIN A S,HIROSE H,et al. Outcome of organs procured from donors on extracorporeal membrane oxygenation support:an analysis of kidney and liver allograft data[J]. Clin Transplant,2014,28(7):816-820. DOI:10. 1111/ctr. 12384.