التفاصيل البيبلوغرافية
| العنوان: |
Retrieval of severe acute respiratory failure patients on extracorporeal membrane oxygenation: Any impact on their outcomes? |
| المؤلفون: |
Bréchot, Nicolas, Mastroianni, Ciro, Schmidt, Matthieu, Santi, Francesca, Lebreton, Guillaume, Hoareau, Anne-Marie, Luyt, Charles-Edouard, Chommeloux, Juliette, Rigolet, Marina, Lebbah, Said, Hekimian, Guillaume, Leprince, Pascal, Combes, Alain |
| المصدر: |
Journal of Thoracic & Cardiovascular Surgery; Apr2018, Vol. 155 Issue 4, p1621-1629.e2, 1p |
| مستخلص: |
Objective Mobile extracorporeal membrane oxygenation (ECMO) retrieval teams (MERTs) assure ECMO implantation and under-ECMO retrieval of patients with most severe acute respiratory failure (ARF) to experienced ECMO centers. Although described as feasible, mobile ECMO has only been poorly evaluated in comparison with on-site implantation. This study was undertaken to compare the indications, characteristics, and outcomes of MERT-implanted patients with venovenous (VV)-ECMO versus those implanted on site in our intensive care unit (ICU). Methods Retrospective, single-center study. Results Among 157 VV-ECMO implantations from 2008 to 2012, the MERT hooked up 118 (75%) patients with refractory ARF, as reflected by their median partial pressure of O 2 in arterial blood/fraction of inspired oxygen of 58 (interquartile range, 50–73). ARF was accompanied by severe multiorgan failure, with a median Simplified Acute Physiology Score-II of 71 (61-81), median Sequential Organ Failure Assessment score of 14 (10-16), and with 82% of the patients receiving inotropes. All patients were transported by ground ambulance: median distance was 15 (6-25) km, and median transport time was 35 (25-35) minutes, during which no major ECMO system–related event occurred. For the MERT- and on-site–implanted groups, ICU mortality was comparable (46.6% vs 53.8%, respectively, P = .5), as were ECMO-related complication rates (53.4% of MERT vs 53.8% of on-site–implanted groups, P = 1.0). According to multivariable analysis, MERT ECMO implantation was not associated with ICU mortality (odds ratio, 1.1; 95% confidence interval, 0.4-2.7; P = .85). Conclusions ICU mortality and ECMO-related complications of patients with MERT-implanted VV-ECMO who were transferred to our ECMO referral center were comparable with those implanted on site by the same team, thereby supporting this strategy to manage patients with severe ARF. [ABSTRACT FROM AUTHOR] |
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