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      Interprofessional two-man team approach for interhospital transport of ARDS-patients under extracorporeal membrane oxygenation: a 10 years retrospective observational cohort study

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          Abstract

          Background

          Extra Corporeal Membrane Oxygenation (ECMO) has become an accepted treatment option for severely ill patients. Due to a limited availability of ECMO support therapy, patients must often be transported to a specialised centre before or after cannulation. According to the ELSO guidelines, an ECMO specialist should be present for such interventions. Here we describe the safety and efficacy of a reduced team approach involving one anaesthesiologist, experienced in specialised intensive care medicine, and a specialised critical care nurse.

          Methods

          This study is a 10 years retrospective, single institution analysis of all data collected between January 2007 and December 2016 from the medical records at the University Hospital Bonn, Germany.

          Results

          The Bonner mobile ECMO team was deployed in 170 cases for on-site evaluation for ECMO support therapy. 4 (2.4%) patients died prior to arrival or during the implementation of ECMO support. Of the remaining 166 patients, 126 were cannulated at the referring site, 40 were transported without ECMO. Of those, 21 were subsequently cannulated out our centre. 19 patients never received ECMO treatment. The primary indication for ECMO treatment was ARDS (159/166 patients). Veno-venous ECMO was initiated in 137, whilst 10 patients received veno-arterial ECMO treatment. Mean transportation time was 75 ± 36 min, and mean transport distance was 56 ± 57 km. In total, 26 complications were observed, three being directly transport-related. The overall survival was 55%.

          Conclusions

          Initiation of extracorporeal membrane oxygenation and subsequent transport can be safely and efficiently performed by a two-man team with good outcome.

          Electronic supplementary material

          The online version of this article (10.1186/s12871-019-0687-9) contains supplementary material, which is available to authorized users.

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          Most cited references16

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          A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.

          J R Le Gall, S Lemeshow, F Saulnier (1993)
          To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality. The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries. The 13,152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded. Vital status at hospital discharge. The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P = .883 and P = .104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample. The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units.
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            APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.

            WILLIAM A. KNAUS, JACK E. ZIMMERMAN, DOUGLAS P. WAGNER … (1981)
            Investigations describing the utilization pattern and documenting the value of intensive care are limited by the lack of a reliable and valid classification system. In this paper, the authors describe the development and initial validation of acute physiology and chronic health evaluation (APACHE), a physiologically based classification system for measuring severity of illness in groups of critically ill patients. APACHE uses information available in the medical record. In studies on 582 admissions to a university hospital ICU and 223 admissions to a community hospital ICU, APACHE was reliable in classifying ICU admissions. In validation studies involving these 805 admissions, the acute physiology score of APACHE demonstrated consistent agreement with subsequent therapeutic effort and mortality. This was true for a broad range of patient groups using a variety of sensitivity analyses. After successful completion of multi-institutional validation studies, the APACHE classification system could be used to control for case mix, compare outcomes, evaluate new therapies, and study the utilization of ICUs.
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              An expanded definition of the adult respiratory distress syndrome.

              J F Murray, M Matthay, J Luce … (1988)
              Article 0 comments Cited 388 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Stefan Felix Ehrentraut: stefan.ehrentraut@ukbonn.de
                Barbara Schroll: barbara.c.schroll@gmail.com
                Stefan Lenkeit: stefan.lenkeit@ukbonn.de
                Heidi Ehrentraut: heidi.ehrentraut@ukbonn.de
                Christian Bode: christian.bode@ukbonn.de
                Stefan Kreyer: stefan.kreyer@ukbonn.de
                Florian Kögl: florian.koegl@ukbonn.de
                Felix Lehmann: felix.lehmann@ukbonn.de
                Thomas Muders: thomas.muders@ukbonn.de
                Martin Scholz: martin.scholz@ukbonn.de
                Claudia Strater: claudia.strater@ukbonn.de
                Folkert Steinhagen: folkert.steinhagen@ukbonn.de
                Nils Ulrich Theuerkauf: nils.theuerkauf@ukbonn.de
                Carsten Weißbrich: carsten.weissbrich@ukbonn.de
                Christian Putensen: christian.putensen@ukbonn.de
                Jens-Christian Schewe:
                ORCID: http://orcid.org/0000-0002-6408-0607
                jens-christian.schewe@ukbonn.de
                Journal
                Journal ID (nlm-ta): BMC Anesthesiol
                Journal ID (iso-abbrev): BMC Anesthesiol
                Title: BMC Anesthesiology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2253
                Publication date (Electronic): 31 January 2019
                Publication date PMC-release: 31 January 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 19
                Affiliations
                ISNI 0000 0000 8786 803X, GRID grid.15090.3d, Department of Anaesthesiology and Intensive Care Medicine, , University Hospital Bonn, ; Sigmund-Freud-Str. 25, 53105 Bonn, Germany
                Author information
                http://orcid.org/0000-0002-6408-0607
                Article
                Publisher ID: 687
                DOI: 10.1186/s12871-019-0687-9
                PMC ID: 6357391
                PubMed ID: 30704395
                SO-VID: a41d2699-75f5-4834-aa7c-47c0f6ec8462
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 17 October 2018
                Date accepted : 16 January 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ecmo,interfacility transport,ards,transport safety,transport efficiency
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ecmo, interfacility transport, ards, transport safety, transport efficiency

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