Extracorporeal Membrane Oxygenation and Interfacility Transfer: A Regional Referral Experience.

Autor:	Ranney DN; Department of Surgery, Duke University Medical Center, Durham North Carolina., Bonadonna D; Perfusion Services, Duke University Medical Center, Durham North Carolina., Yerokun BA; Department of Surgery, Duke University Medical Center, Durham North Carolina., Mulvihill MS; Department of Surgery, Duke University Medical Center, Durham North Carolina., Al-Rawas N; Department of Anesthesiology, Duke University Medical Center, Durham North Carolina., Weykamp M; Department of Surgery, Duke University Medical Center, Durham North Carolina., Gunasingha RM; Department of Surgery, Duke University Medical Center, Durham North Carolina., Bartz RR; Department of Anesthesiology, Duke University Medical Center, Durham North Carolina., Haney JC; Department of Surgery, Duke University Medical Center, Durham North Carolina., Daneshmand MA; Department of Surgery, Duke University Medical Center, Durham North Carolina. Electronic address: mani.daneshmand@dm.duke.edu.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2017 Nov; Vol. 104 (5), pp. 1471-1478. Date of Electronic Publication: 2017 Jun 30.
DOI:	10.1016/j.athoracsur.2017.04.028
Abstrakt:	Background: The number of adults referred to high-volume centers for extracorporeal membrane oxygenation (ECMO) is increasing. Outcomes of patients requiring transport are not well characterized, and referral guidelines are lacking. This study describes the experience and outcomes of a single high-volume center. Methods: A retrospective study was performed that included adults undergoing ECMO between June 2009 and December 2015. Patient characteristics and outcomes were acquired from the medical record. Logistic regression was used to identify predictors of survival to hospital discharge. The Kaplan-Meier method was used to depict rates of survival. Results: Of 133 patients, 77 (57.9%) underwent venoarterial (VA) ECMO and 56 (42.1%) underwent venovenous (VV) ECMO. Median transport distance was 88.8 miles (range 0.2-1,434 miles). Median duration of support was 6 days (range, 1-32.5 days). Age older than 60 years, pulmonary hypertension, and body mass index (BMI) greater than 30 were associated with worse survival to discharge for VA ECMO; a history of hypertension and presence of left ventricular (LV) vent were associated with better survival. Age older than 60 years and diabetes were associated with worse survival to hospital discharge for VV ECMO. Survival to decannulation was 66.2% and 76.8%, and to hospital discharge it was 48.1% and 69.6% for VA and VV ECMO, respectively. Of hospital survivors, Kaplan-Meier estimates of 1-year survival were 82.4% and 95.5% for VA and VV, respectively. Conclusions: Outcomes are favorable after transport to high-volume ECMO centers. Guidelines and infrastructure for short- and long-distance ECMO transport is imperative for the efficient and successful management of these patients. (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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