移动体外膜肺氧合在小儿急性呼吸窘迫综合征院际转运中的应用:7例回顾性病例研究

Application of mobile extracorporeal membrane oxygenation in inter-hospital transport of pediatric acute respiratory distress syndrome:retrospective studies for 7 case

目的探讨移动体外膜肺氧合(ECMO)在小儿急性呼吸窘迫综合征(pARDS)院际转运中的应用情况及其安全性。方法回顾性分析2019年1月1日-11月25日广东省人民医院通过移动ECMO转运的pARDS患儿。所有患儿均为严重的ARDS,在当地医院治疗效果欠佳,经机械通气、小潮气量保护性通气、俯卧位通气、限制液体等传统的非手术治疗方案处理,病情仍然进展,病变严重程度达到适用ECMO的指征。收集并分析所有患儿的年龄、性别、临床表现、ECMO转运时间、ECMO转运距离、ECMO支持时间、机械通气时间、住院时间、预后及并发症发生情况等指标。结果共7例患儿纳入研究,男6例,女1例,年龄(43.3±42.9)个月,体重(18.4±17.7)kg,ECMO转运距离为(9.4±8.9)km,ECMO转运时间为(35.7±17.2)min。抵达广东省人民医院后,目前4例治愈出院,1例还在继续治疗中,2例死亡。机械通气时间为(17±11)d,ECMO支持时间为(307.4±233.6)h,住院时间为(23±15)d。pARDS患儿中4例为腺病毒感染,3例病原菌不明确。2例死亡患儿中,1例死亡原因为严重脓毒症休克合并严重心功能障碍,1例死亡原因为严重肺出血。结论在具备技术娴熟的ECMO团队的条件下,pARDS患儿的移动ECMO院际转运是安全有效的。移动ECMO为救治儿童呼吸危重症提供了很好的手段。

Objective To investigate the application and safety of mobile extracorporeal membrane oxygenation(ECMO)in inter-hospital transport of pediatric patients with acute respiratory distress syndrome(pARDS).Methods Data were retrospectively collected of children with pARDS transported by mobile ECMO from Jan.1,2019 to Nov.25,2019.All children suffered from severe ARDS,and the curative effect in their local hospital was not good,the disease was still progressing after traditional conservative treatments such as mechanical ventilation(MV),small tidal volume protective ventilation,prone position ventilation,and fluid restriction,and the severity of the disease reached the applicable ECMO indications.The age,sex,clinical manifestations,ECMO transfer time,ECMO transfer distance,ECMO duration,MV duration,length of hospital stay,prognosis and complications were collected and analyzed.Results Seven pediatric patients were included in present study including 6 males and 1 female,aged(43.3±42.9)months,body weight(18.4±17.7)kg,ECMO travel distance(9.4±8.9)km,and ECMO travel time(5.7±17.2)min.After arriving in the Guangdong Provincial People’s Hospital,6 pediatric patients(4 were cured and 2 died)were discharged and 1 pediatric patient was still being treated.The MV duration was(17±11)d,ECMO duration was(307.4±233.6)h,and the length of hospital stay was(23±15)d.Of the 7 pediatric patients,4 were caused by adenovirus infection,and the other 3 cases were infected by unclear pathogenic bacteria.The cause for death was severe sepsis shock combined with severe heart dysfunction and severe pulmonary hemorrhage.Conclusions With a skilled ECMO teams,mobile ECMO may provide a safe and effective inter-hospital transport of pARDS patients.Mobile ECMO provides a good way to treat children patients with respiratory critical condition.