A 266 Patient Experience of a Quaternary Care Referral Center for Extracorporeal Membrane Oxygenation with Assessment of Outcomes for Transferred Versus In-House Patients
A 266 Patient Experience of a Quaternary Care Referral Center for Extracorporeal Membrane Oxygenation with Assessment of Outcomes for Transferred Versus In-House Patients
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DOI：
10.1053/j.jvca.2019.05.017
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发表时间：
2019-11-01
影响因子：
2.8
通讯作者：
Ortoleva, Jamel
中科院分区：
文献类型：
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作者：
Dalia, Adam A.;Axtel, Andrea;Ortoleva, Jamel
目的：接受静脉动脉体外膜肺氧合（VA-ECMO）的患者需要经过高度培训的专家和资源才能得到安全的护理。有趣的是，由外部机构插管进行VA-ECMO并转移到转诊中心接受进一步治疗的患者与在转诊中心插管并在内部接受治疗的患者的结局比较尚未大规模报道。本研究旨在根据单个四级转诊中心的经验对这2个人群进行首次比较。设计：在单个四级护理中心进行一项基于回顾性图表回顾的研究，研究对象是由转诊机构插管进行VA-ECMO然后转移的患者与在室内插管的患者，以评估生存差异（包括ECMO治疗和出院生存率）。地点：ECMO的单一四级学术转诊中心。参与者：2011-2018年期间接受VA-ECMO的所有患者，年龄≥ 18岁（266例患者）。干预：无。测量和主要结果：该研究包括215例在室内进行VA-ECMO插管的患者和51例由17个不同的外部机构插管然后转移的患者。内部患者（122/215）的ECMO运行生存率为56.7%（95%置信区间[CI] 50.1-63.3），转移患者（31/51）的ECMO运行生存率为60.8%（95% CI 47.4-74.2; p = 0.58）。在室内插管的患者（82/215）的出院生存率为38.1%（95% CI 31.6-44.6）和院外转移（24/51例患者）为47.1%（95% CI 33.4-60.8; p = 0.23）。这项对266例患者的回顾性病历审查发现，在其他机构插管并转移的患者中，ECMO治疗的生存率或出院生存率与在其他机构插管并转移的患者相比无差异。房子尽管已经在需要静脉-静脉ECMO的呼吸衰竭患者中广泛进行了转运中心可行性分析，但在需要VA-ECMO的患者中进行的研究很少。这些结果应被视为假设生成，因为更大的样本量是必要的，以指导这些患者的护理更明确。(C)2019爱思唯尔公司All rights reserved.
Objective: Patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) require highly trained specialists and resources to be cared for safely. Interestingly, comparisons of outcomes for patients cannulated for VA-ECMO by outside institutions and transferred to referral centers for further care versus those cannulated and taken care of in house at the referral center have not been reported on a large scale. This study aimed to perform the first comparison of these 2 populations based on the experience of a single quaternary referral center.Design: A retrospective chart review-based study in a single quaternary care center of patients cannulated by referring institutions for VA-ECMO then transferred versus patients who were cannulated in house was performed to assess for a difference in survival (both of ECMO therapy and survival to discharge).Setting: Single quaternary academic referral center for ECMO.Participants: All patients undergoing VA-ECMO who were at least 18 years old from 2011-2018 (266 patients).Intervention: None.Measurements and Main Results: The study comprised 215 patients cannulated for VA-ECMO in house and 51 patients cannulated by 17 different outside institutions then transferred. Survival of the ECMO run for in-house patients (122/215) was 56.7% (95% confidence interval [CI] 50.1-63.3), and survival of transferred patients (31/51) for the ECMO run was 60.8% (95% CI 47.4-74.2; p = 0.58). Survival to discharge in patients cannulated in house (82/215) was 38.1% (95% CI 31.6-44.6) and for outside hospital transfers (24/51 patients) was 47.1% (95% CI 33.4-60.8; p = 0.23).Conclusions: This retrospective chart review of 266 patients found no difference in survival of the ECMO therapy or survival to discharge in patients cannulated by other institutions and transferred versus those who were cannulated in house. Even though analysis on the feasibility of transfer centers has been performed extensively in patients with respiratory failure requiring venovenous ECMO, minimal investigation has been performed in patients requiring VA-ECMO. These results should be considered hypothesis-generating because larger sample sizes are necessary to guide care of these patients more definitively. (C) 2019 Elsevier Inc. All rights reserved.