Interfacility transport with extracorporeal membrane oxygenation in pediatric patients: a multicenter study in China
10.3760/cma.j.issn.0578-1310.2019.05.007
- VernacularTitle: 中国大陆儿科体外膜肺氧合转运的多中心调查分析
- Author:
Xiaoyang HONG
1
;
Dongliang CHENG
2
;
Ru LIN
3
;
Changsong SHI
2
;
Gangfeng YAN
4
;
Zhe ZHAO
1
;
Yingyue LIU
1
;
Zhili LI
5
;
Qiang YU
5
;
Xiaojuan ZHANG
1
;
Yan XING
2
;
Guoping LU
4
;
Zhichun FENG
1
Author Information
1. Pediatric Intensive Care Unit, Bayi Children′s Hospital, the 7th Medical Center of PLA General Hospital, Beijing 100700, China
2. Pediatric Intensive Care Unit, Henan Provincial People′s Hospital, Zhengzhou 450000, China
3. Cardiopulmonary Bypass Department, Children′s Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
4. Pediatric Intensive Care Unit, Pediatric Hospital of Fudan University, Shanghai 201102, China
5. Beichuang Power (Beijing) Technology Development Co., Ltd., Beijing 100070, China
- Publication Type:Journal Article
- Keywords:
Extracorporeal membrane oxygenation;
Multicenter study;
Critical illness
- From:
Chinese Journal of Pediatrics
2019;57(5):350-354
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China.
Methods:The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test.
Results:All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO2 or SaO2 before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO2 and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ2=0.615, P>0.05; 4/28 vs. 2/14, χ2=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ2=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ2=0.845, P>0.05; 6/42 vs. 7/50, χ2=0.001, P>0.05; 29/19 vs. 38/19, χ2=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ2=0.775, P>0.05; 32/48 vs. 35/57, χ2=0.313, P>0.05; 20/48 vs. 22/57, χ2=0.102, P>0.05).
Conclusion:With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.
