ECMO患者救护车长途转运的临床分析

Clinical analysis of ECMO patients transported by ambulance in long distance transfer

目的对2018年11月—2020年10月中南大学湘雅三医院应用体外膜肺氧合技术(ECMO)顺利完成救护车院间长途转运的12例重症患者进行临床分析,总结经验教训,探讨救护车长途转运ECMO患者的科学和安全稳妥的流程。方法转运前充分评估ECMO患者的生命体征,特别是血压和血氧饱和度监测;转运过程中充分镇静镇痛,严密监测患者的生命体征和ECMO系统血流峰值的变化,强调液路和通气管路的管理;转运到目的医院后对患者进行重新评估,细致整理好各种管路后才能下车,确保整个转运过程的安全。结果12例ECMO重症患者全部经救护车长途转运安全转至本院。转运距离75~409 km,运转时间1.5~6.4 h,转运过程中均发生不同程度的不良事件,全部现场处理后纠正。结论充分评估与再评估、充分镇静镇痛、严密监测患者的生命体征特别是ECMO系统血流峰值的变化、重视液路和通气管路的管理是ECMO重症患者救护车长途转运的四件法宝。

Objective To analyze the 12 Extracorporeal Membrane Oxygenation(ECMO)patients transported by ambulance from November 2018 to October 2020 in long-distance transfer and find a kind of safe and potent method of long-distance transportation.Methods To fully estimate the vital signs(especially monitor their blood pressure and oxygen saturation)before transportation.Protocol for sedation and analgesia,full monitor of peak blood flow of ECMO system and careful management of fluid path and vent line were necessary in the course of transportation.The reassessment of vital signs and putting pipelines in order were very important when the ambulance reached the aim hospital.Results All of the 12 ECMO patients were transported by ambulance.The distance of transportation ranged from 75 km to 409 km,and the transport time cost between 1.5 hour to 6.4 hours.During the intercourse of transportation,there were all kinds of adverse events that corrected rapidly.Conclusion It is feasible and secure for ECMO patients transported by ambulance even though in long-distance transfer at the cost of full assessment and reassessment of the vital signs,protocol for sedation and analgesia,full monitor of peak blood flow of ECMO system and careful management of fluid path and vent line.