移动中的救护车.ppt

ECMO Transport ECMO Transport Intra-hospital ECMO transport Inter-hospital ECMO transport Intra-hospital ECMO Transport ECMO set-up site ICU OR Catheterization room ES Ward anywhere Inter-hospital ECMO Transport 移動中的救護車 空間狹小 比較: 加護病房標準床位 ? 20m2 溫度 (不足) 防止散熱的措施 ? 阻礙診斷及治療 移動 (震動, 加速度) 移動中的救護車 不適於診斷及治療病人 運送前準備所需的監測多於 運送時所需的監測 例如 運送前測C.O., 但運送中不測 Catecholamine Pump infusion inotropes must use infusion pump pump to pump at most 2 kinds (if many, simplify) 出發前最後的準備 Simplifying treatment: 例如 multiple catecholamine infusion low dose dopamine NTG infusion Sedative drug infusion etc Drain tube Prevent heat loss Ambulance: fuel oxygen infusion drug Patient’s data Inter-hospital ECMO transport Personnel: usually 3 persons CVS surgeon ECMO technician Fellow, resident Inter-hospital ECMO Transport 1998 Jan ~ 2004 Jul 31 adult cardiac ECMO inter-hospital transport Distance: 3 ~300 Km (median: 200 Km) Outcome Wean-off: 11 Bridge to VAD: 8 Bridge to HTx: 1 Die on ECMO: 11 (poor neurological status:7, MOF:4) Cf: in-hospital adult cardiac ECMO (excluding ECPR) at NTUH survival rate: 32.8%, n=64 CF: ELSO registry: adult cardiac ECMO survival rate:33%, n=474 Comparison between the survivors and non-survivors Prognostic factors Early transfer (2 days) Low LOD scores Taipei city/Taipei county area = 12 64.5%, 10(32.1%) survival to discharge * All you need to set up ECMO Put everything on the wheel Then, OR, ICU, cath room, ES, ward, etc ECMO cart System symplification 2005 Jan. ELSO registry ECMO center in the world *