Characterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil

ABSTRACT Objective: To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support. Methods: A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database. Results: From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84 (68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 - 82) km was traveled on each rescue mission during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three (2 - 3) physicians, and one (0 - 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis. Conclusions: Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.

摘要 研究目的：本研究旨在明确接受体外呼吸或循环支持的重症患者的转运情况。研究方法：本研究对巴西圣保罗州的18例患者进行了系列病例描述。所有患者均由初始收治医院的多学科团队进行连续性评估。先对患者开展急救，并在现场建立体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）支持，随后将患者转运至具备体外膜肺氧合支持能力的转诊医院。研究数据来自前瞻性收集的数据库。研究结果：2011年至2017年间，共转运18例患者，年龄中位数为29岁（四分位距25~31岁），简化急性生理学评分3（SAPS 3）中位数为84分（四分位距68~92分），主要原发诊断为钩端螺旋体病与甲型H1N1流感病毒感染，患者被转运至圣保罗州的3家转诊医院。每次急救转运的行程中位数为39km（四分位距15~82km），转运时长中位数为360min（四分位距308~431min）。每次急救转运的随行人员中位数为：护士1名（四分位距0~2名）、医师3名（四分位距2~3名）、物理治疗师1名（四分位距0~1名）。其中17次转运采用救护车完成，1次采用直升机完成。观察到的并发症包括2例（11%）泵能量供应中断，以及2例血氧饱和度低于70%。13例患者（72%）存活并出院。非存活患者中，2例为脑死亡，2例为多器官功能障碍综合征（multiple organ dysfunction syndrome, MODS），1例为不可逆性肺纤维化。研究结论：接受体外支持的重症患者转运未发生严重并发症，且院内存活率较高。