体外膜肺氧合支持下患者院内转运安全管理的最佳证据总结

Evidence summary of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation

目的检索、评价并总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助支持下患者行院内转运安全管理的最佳证据,为临床实践提供参考。方法计算机检索BMJ Best Practice、UpToDate、加拿大安大略注册护士协会网、美国国立指南数据库、英国国家卫生与临床优化研究所指南库、医脉通、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、Cochrane Library、CINAHL、PubMed、中国知网、万方数据库和体外生命支持组织网站中与ECMO患者院内转运安全管理相关的临床指南、专家共识、证据总结、系统评价,并补充检索设计良好的原始研究,检索时限为建库至2021年8月。采用JBI循证卫生保健中心的文献评价标准和证据分级系统,进行文献质量评价及证据级别评定。结果共纳入11篇文献,其中专家共识5篇、系统评价2篇、随机对照试验1篇、类实验研究1篇、队列研究1篇、横断面调查1篇,共总结出30条关于ECMO患者院内转运安全管理的最佳证据,涉及转运团队组成及能力要求、转运前准备、转运中监测、不良事件防控和转运交接管理5个方面。结论建议结合医院实际情况构建专业化的ECMO患者院内转运团队,应用最佳证据规范ECMO患者院内转运流程,建立不良事件防控体系,保证患者安全。

Objective To retrieve,evaluate and summarize the best evidence of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation(ECMO),and to provide a reference for clinical practice.Methods The BMJ Best Practice,UpToDate,Registered Nurses’Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,CNKI,Wanfang Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including guidelines,consensuses,evidence summaries,systematic reviews,and well-designed original studies.The time limit for the retrieval is from the inception of databases until August 2021.Results 11 pieces of the literature were retrieved,including 5 consensuses,2 system reviews,1 randomized controlled trial,1 quasi-experimental study,1 cohort study and 1 cross-section survey.Totally 30 pieces of evidence were summarized,including team composition and ability requirements,transport preparation,monitoring during transport,prevention and control of adverse events and management of handover.Conclusion It is suggested to build a professional ECMO intra-hospital transport team based on the actual hospital situation,to apply the best evidence to standardize the intra-hospital transport process of patients on ECMO,and to establish an adverse event prevention and control system and information communication mechanism to ensure patient safety.