Implementation of Extracorporeal Membrane Oxygenation Without On-Site Cardiac Surgery or Perfusion Support: A Tale of Two County Hospitals.
Implementation of Extracorporeal Membrane Oxygenation Without On-Site Cardiac Surgery or Perfusion Support: A Tale of Two County Hospitals.
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在没有现场心脏手术或灌注支持的情况下实施体外膜氧合：两家县医院的故事。
DOI：
10.1097/mat.0000000000001883
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Johnson,NicholasJ
中科院分区：
文献类型：
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作者：
Bilodeau,KyleS;Badulak,Jenelle;Bulger,Eileen;Stewart,Barclay;Mandell,SamuelP;Taylor,Mark;Condella,Anna;Carlson,MichelleD;Kohl,LouisP;Simpson,NicholasS;Heather,Beth;Prekker,MatthewE;Johnson,NicholasJ
难治性呼吸和心力衰竭的患者可能会出现在非心脏外科中心。先前的研究已经证明，急诊外科医生、重症医生和急诊内科医生可以安全地插管和处理接受体外膜氧合(ECMO)的患者。哈博维尤医疗中心(Harborview)和亨内平县医疗中心(Hennepin)都是城市、县所有的1级创伤中心，在没有直接的现场心脏手术或灌流支持的情况下实施ECMO。这两个中心1)采用ECMO专科模式，配备受过专门培训的护士和呼吸治疗师，2)为ECMO专科医生、重症医生、外科医生和实习生开发了类似的培训课程。每个方案都从静脉-静脉ECMO开始，为难治性低氧性呼吸衰竭提供支持，随后扩展到静脉-动脉ECMO支持。2019年冠状病毒病(新冠肺炎)大流行推动了结构调整，每个项目都创建了一项咨询服务，以促进跨多个重症监护病房(ICU)的ECMO交付，并促进同事和住院医生的培训和经验。Harborview和Hennepin都是相距1700英里的美国城市县医院，它们独立实施和运营成人ECMO计划，而不涉及心血管手术或灌流服务。这一经验进一步支持了ECMO专家在提供体外生命支持方面的作用。
Patients with refractory respiratory and cardiac failure may present to noncardiac surgery centers. Prior studies have demonstrated that acute care surgeons, intensivists, and emergency medicine physicians can safely cannulate and manage patients receiving extracorporeal membrane oxygenation (ECMO). Harborview Medical Center (Harborview) and Hennepin County Medical Center (Hennepin) are both urban, county-owned, level 1 trauma centers that implemented ECMO without direct, on-site cardiac surgery or perfusion support. Both centers 1) use an ECMO specialist model staffed by specially trained nurses and respiratory therapists and 2) developed comparable training curricula for ECMO specialists, intensivists, surgeons, and trainees. Each program began with venovenous ECMO to provide support for refractory hypoxemic respiratory failure and subsequently expanded to venoarterial ECMO support. The coronavirus disease 2019 (COVID-19) pandemic created an impetus for restructuring, with each program creating a consulting service to facilitate ECMO delivery across multiple intensive care units (ICUs) and to promote fellow and resident training and experience. Both Harborview and Hennepin, urban county hospitals 1,700 miles apart in the United States, independently implemented and operate adult ECMO programs without involvement from cardiovascular surgery or perfusion services. This experience further supports the role of ECMO specialists in the delivery of extracorporeal life support.