smpСкорая медицинская помощьEMERGENCY MEDICAL CARE2072-6716Northwest State Medical University named after II Mechnikov10.24884/2072-6716-2021-22-2-64-68smp-487Research ArticleСТАТЬИARTICLESМежбольничные перевозки на экстракорпоральной мембранной оксигенации в различных системах здравоохраненияInter-hospital transport on extracorporeal membrane oxygenation in various health systemsВасильевВ. В.VasilevV. V.

Васильев Владимир Владимирович — кандидат  медицинских наук, доцент кафедры скорой и неотложной помощи.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1

Vladimir V. Vasilev

confader@yandex.ruВасильеваИ. С.VasilevaI. S.

Васильева Ирина Сергеевна — кандидат  медицинских наук, ассистент кафедры скорой и неотложной помощи; SPIN: 5099–0841.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1

Irina S. Vasileva

emmans@rambler.ruМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияMoscow regional research clinical Institute named after M.F. VladimirskyRussian Federation2021080620212226468Copyright © Васильев В.В., Васильева И.С., 20212021Васильев В.В., Васильева И.С.Vasilev V.V., Vasileva I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://smp.spb.ru/jour/article/view/487

Признание возможности транспортировки на экстракорпоральной мембранной оксигенации (ЭКМО) и ее достижение ее осуществления относятся к 1970-м годам. В начале второго тысячелетия количество транспортных средств по всему миру было менее 20. В 2009 г. пандемия H1N1 и публикация, показывающая улучшение выживаемости взрослых пациентов, доставленных в больницу с ресурсами ЭКМО, повысили осведомленность и интерес к лечению ЭКМО. Количество транспортных организаций стремительно росло. На сегодняшний день количество транспортных организаций во всем мире увеличивается, хотя некоторые центры, где ЭКМО является установленным лечением, сообщают о сокращении количества транспортировок. С момента появления более удобного в использовании оборудования (эра ЭКМО-2) все больше центров ЭКМО с малым объемом операций проводят эти сложные процедуры. Настоящий обзор основан на современной литературе и информации из сети авторов по организации транспортных систем ЭКМО в различных условиях здравоохранения по всему миру. Данные реестра с момента входа в ЭКМО-2 показывают, что количество процедур ЭКМО возрастает. Чем больше процедур проводится в данном центре, тем лучше результаты для пациента и тем лучше расходуются эти ресурсы для обслуживаемого населения. Модель Hub-and-S poke для национальной или региональной орга-низации респираторной ЭКМО (rECMO) должна быть рекомендована там, где центральный центр ЭКМО с большим объемом (Hub) обслуживает население от 10 до 15 млн. Периферийные устройства (спицы) играют важную роль в экстренной катетеризации, поддерживая пациента на ЭКМО до тех пор, пока мобильная бригада не заберет пациента. Эту группу ЭКМО предпочтительно организовывать из центра, и она обладает компетенциями для оценки и принятия решения о начале лечения ЭКМО у постели больного в любой больнице для канюляции и безопасного транспорта в любое место.

The feasibility and the recognition of the possibility to transport patients on extracorporeal membrane oxygenation (ECMO) aroused in the 1970s. The number of transporting facilities worldwide was less than 20 in the beginning of the second Millennium. In 2009 the H1N1 pandemic and a publication showing survival benefit for adult patients transported to a hospital with ECMO resource increased both awareness and interest for ECMO treatment. The number of transport organizations increased rapidly. As of today, the number of transport organizations increases world-wide, though some centers where ECMO is an established treatment report decreasing numbers of transports. Since the introduction of the more user-friendly equipment (ECMO-2 era) increasing numbers of low-volume ECMO centers perform these complex treatments. This overview is based on the current literature, personal experience in the field, and information from the authors’ network on the organization of ECMO transport systems in different settings of health care around the globe. Registry data since the entry into ECMO-2 shows that the number of ECMO treatments matter. The more treatments performed at a given center the better the patient outcome, and the better these resources are spent for the population served. A Hub-and-S poke model for national or regional organization for respiratory ECMO (rECMO) should be advocated where central high-volume ECMO center (Hub) serves a population of 10 to 15 million. Peripheral units (Spokes) play an important part in emergency cannulations keeping the patient on ECMO support till a mobile ECMO team retrieves the patient. This ECMO team is preferably organized from the Hub and brings competencies for assessment and decision to initiate ECMO treatment bedside at any hospital, for cannulation, and a safe transport to any destination.

экстракорпоральная мембранная оксигенация (ЭКМО)транспортмобильный транспортмежбольничный транспортextracorporeal membrane oxygenation (ECMO)transportmobileinter-hospitalReferencesBartlett R.H., Gazzaniga A. B., Fong S. W. et al. Extracorporeal membrane oxygenator support for cardiopulmonary failure. Experience in 28 cases // J. Thorac. Cardiovasc. Surg. 1977. Vol. 73. Р. 375–386.Bartlett R.H., Gazzaniga A. B., Fong S. W. et al. Extracorporeal membrane oxygenator support for cardiopulmonary failure. Experience in 28 cases // J. Thorac. Cardiovasc. Surg. 1977. Vol. 73. Р. 375–386.Forrest P., Ratchford J., Burns B. et al. Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience // Intensive Care Med. 2011. Vol. 37. Р. 824–830.Forrest P., Ratchford J., Burns B. et al. Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience // Intensive Care Med. 2011. Vol. 37. Р. 824–830.Boedy R.F., Howell C. G., Kanto W. P. Jr. Hidden mortality rate associated with extracorporeal membrane oxygenation // J. Pediatr. 1990. Vol. 117. Р. 462–464.Boedy R.F., Howell C. G., Kanto W. P. Jr. Hidden mortality rate associated with extracorporeal membrane oxygenation // J. Pediatr. 1990. Vol. 117. Р. 462–464.Peek G.J., Mugford M., Tiruvoipati R. et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial // Lancet. 2009. Vol. 374. Р. 1351–1363.Peek G.J., Mugford M., Tiruvoipati R. et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial // Lancet. 2009. Vol. 374. Р. 1351–1363.Bryner B., Cooley E., Copenhaver W. et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation // Ann. Thorac. Surg. 2014. Vol. 98. Р. 1363–1370.Bryner B., Cooley E., Copenhaver W. et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation // Ann. Thorac. Surg. 2014. Vol. 98. Р. 1363–1370.Clement K.C., Fiser R. T., Fiser W. P. et al. Single-i nstitution experience with interhospital extracorporeal membrane oxygenation transport: A descriptive study // Pediatr. Crit. Care Med. 2010. Vol. 11. Р. 509–513.Clement K.C., Fiser R. T., Fiser W. P. et al. Single-i nstitution experience with interhospital extracorporeal membrane oxygenation transport: A descriptive study // Pediatr. Crit. Care Med. 2010. Vol. 11. Р. 509–513.Broman L.M., Holzgraefe B., Palmér K. et al. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation // Crit. Care. 2015. Vol. 19. 278 р.Broman L.M., Holzgraefe B., Palmér K. et al. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation // Crit. Care. 2015. Vol. 19. 278 р.Foley D.S., Pranikoff T., Younger J. G. et al. A review of 100 patients transported on extracorporeal life support // ASAIO J. 2002. Vol. 48. Р. 612–619.Foley D.S., Pranikoff T., Younger J. G. et al. A review of 100 patients transported on extracorporeal life support // ASAIO J. 2002. Vol. 48. Р. 612–619.Guidelines for ECMO transport. Extracorporeal Life Support Organization (ELSO). USA, MI: Ann Arbor, 2015. [Accessed 2017 August 19]. Available online: https://www.elso.org/Portals/0/Files/ELSO%20GUIDELINES%20FOR%20ECMO%20TRANSPORT_May2015.pdfGuidelines for ECMO transport. Extracorporeal Life Support Organization (ELSO). USA, MI: Ann Arbor, 2015. [Accessed 2017 August 19]. Available online: https://www.elso.org/Portals/0/Files/ELSO%20GUIDELINES%20FOR%20ECMO%20TRANSPORT_May2015.pdfZangrillo A., Biondi-Z occai G., Landoni G. et al. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO // Crit. Care. 2013. Vol. 17. R30.Zangrillo A., Biondi-Z occai G., Landoni G. et al. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO // Crit. Care. 2013. Vol. 17. R30.Bréchot N., Luyt C. E., Schmidt M. et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock // Crit. Care Med. 2013. Vol. 41. Р. 1616–1626.Bréchot N., Luyt C. E., Schmidt M. et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock // Crit. Care Med. 2013. Vol. 41. Р. 1616–1626.Bartlett R.H. ECMO: the next ten years // Egypt J. Crit. Care Med. 2016. Vol. 4. Р. 7–10.Bartlett R.H. ECMO: the next ten years // Egypt J. Crit. Care Med. 2016. Vol. 4. Р. 7–10.Makdisi G., Wang I. W. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology // J. Thorac. Dis. 2015. Vol. 7. Р. E166–176.Makdisi G., Wang I. W. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology // J. Thorac. Dis. 2015. Vol. 7. Р. E166–176.MacLaren G., Combes A., Bartlett R. H. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era // Intensive Care Med. 2012. Vol. 38. Р. 210–220.MacLaren G., Combes A., Bartlett R. H. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era // Intensive Care Med. 2012. Vol. 38. Р. 210–220.Karamlou T., Vafaeezadeh M., Parrish A. M. et al. Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients // J. Thorac. Cardiovasc. Surg. 2013. Vol. 145. Р. 470–475.Karamlou T., Vafaeezadeh M., Parrish A. M. et al. Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients // J. Thorac. Cardiovasc. Surg. 2013. Vol. 145. Р. 470–475.Freeman C.L., Bennett T. D., Casper T. C. et al. Pediatric and neonatal extracorporeal membrane oxygenation: does center volume impact mortality? // Crit. Care Med. 2014. Vol. 42. Р. 512–519.Freeman C.L., Bennett T. D., Casper T. C. et al. Pediatric and neonatal extracorporeal membrane oxygenation: does center volume impact mortality? // Crit. Care Med. 2014. Vol. 42. Р. 512–519.Barbaro R.P., Odetola F. O., Kidwell K. M. et al. Association of hospital-l evel volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry // Am. J. Respir. Crit. Care Med. 2015. Vol. 191. Р. 894–901.Barbaro R.P., Odetola F. O., Kidwell K. M. et al. Association of hospital-l evel volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry // Am. J. Respir. Crit. Care Med. 2015. Vol. 191. Р. 894–901.Combes A., Brodie D., Bartlett R. et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients // Am. J. Respir. Crit. Care Med. 2014. Vol. 190. Р. 488–496.Combes A., Brodie D., Bartlett R. et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients // Am. J. Respir. Crit. Care Med. 2014. Vol. 190. Р. 488–496.National Institute for Health and Care Excellence. Extracorporeal membrane oxygenation for severe acute respiratory failure in adults. Available online: http://www.Nice.Org.Uk/guidance/ipg391.National Institute for Health and Care Excellence. Extracorporeal membrane oxygenation for severe acute respiratory failure in adults. Available online: http://www.Nice.Org.Uk/guidance/ipg391.Vaja R., Chauhan I., Joshi V. et al. Five-year experience with mobile adult extracorporeal membrane oxygenation in a tertiary referral center // J. Crit. Care. 2015. Vol. 30. Р. 1195–1198.Vaja R., Chauhan I., Joshi V. et al. Five-year experience with mobile adult extracorporeal membrane oxygenation in a tertiary referral center // J. Crit. Care. 2015. Vol. 30. Р. 1195–1198.Critical Care Tertiary Referral Networks & Transfer of Care (Adults). The NSW Critical Care Tertiary Referral Networks (Adults). Ministry of Health. New South Wales. Australia. [Accessed 2017 August 19]. Available online: http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2010_021.pdfCritical Care Tertiary Referral Networks & Transfer of Care (Adults). The NSW Critical Care Tertiary Referral Networks (Adults). Ministry of Health. New South Wales. Australia. [Accessed 2017 August 19]. Available online: http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2010_021.pdfECMOnet. Censimento delle Terapie Intensive Italiane. [Accessed 2017 August 19].ECMOnet. Censimento delle Terapie Intensive Italiane. [Accessed 2017 August 19].Isgrò S., Patroniti N., Bombino M. et al. Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience // Int. J. Artif. Organs. 2011. Vol. 34. Р. 1052–1060.Isgrò S., Patroniti N., Bombino M. et al. Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience // Int. J. Artif. Organs. 2011. Vol. 34. Р. 1052–1060.Lucchini A., De Felippis C., Elli S. et al. Mobile ECMO team for inter-h ospital transportation of patients with ARDS: a retrospective case series // Heart Lung. Vessel. 2014. Vol. 6. Р. 262–273.Lucchini A., De Felippis C., Elli S. et al. Mobile ECMO team for inter-h ospital transportation of patients with ARDS: a retrospective case series // Heart Lung. Vessel. 2014. Vol. 6. Р. 262–273.Roger D., Dudouit J. M., Résière D. et al. Interhospital transfer of ECMO-assisted patients in Martinique // Ann. Fr. Anesth. Reanim. 2013. Vol. 32. Р. 307–314.Roger D., Dudouit J. M., Résière D. et al. Interhospital transfer of ECMO-assisted patients in Martinique // Ann. Fr. Anesth. Reanim. 2013. Vol. 32. Р. 307–314.Gariboldi V., Grisoli D., Tarmiz A. et al. Mobile extracorporeal membrane oxygenation unit expands cardiac assist surgical programs // Ann. Thorac. Surg. 2010. Vol. 90. Р. 1548–1552.Gariboldi V., Grisoli D., Tarmiz A. et al. Mobile extracorporeal membrane oxygenation unit expands cardiac assist surgical programs // Ann. Thorac. Surg. 2010. Vol. 90. Р. 1548–1552.Lindén V., Palmér K., Reinhard J. et al. Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation — n ational and international experience // Intensive Care Med. 2001. Vol. 27. Р. 1643–1648.Lindén V., Palmér K., Reinhard J. et al. Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation — n ational and international experience // Intensive Care Med. 2001. Vol. 27. Р. 1643–1648.Broman L.M., Frenckner B. Transportation of Critically Ill Patients on Extracorporeal Membrane Oxygenation // Front Pediatr. 2016. Vol. 4. Р. 63.Broman L.M., Frenckner B. Transportation of Critically Ill Patients on Extracorporeal Membrane Oxygenation // Front Pediatr. 2016. Vol. 4. Р. 63.Ericsson A., Frenckner B., Broman LM. Adverse Events during Inter-H ospital Transports on Extracorporeal Membrane Oxygenation // Prehosp. Emerg. Care. 2017. Vol. 21. Р. 448–455.Ericsson A., Frenckner B., Broman LM. Adverse Events during Inter-H ospital Transports on Extracorporeal Membrane Oxygenation // Prehosp. Emerg. Care. 2017. Vol. 21. Р. 448–455.Javidfar J., Brodie D., Takayama H. et al. Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center // ASAIO J. 2011. Vol. 57. Р. 421–425.Javidfar J., Brodie D., Takayama H. et al. Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center // ASAIO J. 2011. Vol. 57. Р. 421–425.Coppola C.P., Tyree M., Larry K. et al. A 22-year experience in global transport extracorporeal membrane oxygenation // J. Pediatr. Surg. 2008. Vol. 43. Р. 46–52; disc. 52.Coppola C.P., Tyree M., Larry K. et al. A 22-year experience in global transport extracorporeal membrane oxygenation // J. Pediatr. Surg. 2008. Vol. 43. Р. 46–52; disc. 52.Wiegersma J.S., Droogh J. M., Zijlstra J. G. et al. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team // Crit. Care. 2011. Vol. 15. R75.Wiegersma J.S., Droogh J. M., Zijlstra J. G. et al. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team // Crit. Care. 2011. Vol. 15. R75.Biscotti M., Agerstrand C., Abrams D. et al. One Hundred Transports on Extracorporeal Support to an Extracorporeal Membrane Oxygenation Center // Ann. Thorac. Surg. 2015. Vol. 100. Р. 34–39; disc. 39–40.Biscotti M., Agerstrand C., Abrams D. et al. One Hundred Transports on Extracorporeal Support to an Extracorporeal Membrane Oxygenation Center // Ann. Thorac. Surg. 2015. Vol. 100. Р. 34–39; disc. 39–40.Lunz D., Philipp A., Judemann K. et al. First experience with the deltastream(R) DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-h ospital transport // Interact Cardiovasc. Thorac. Surg. 2013. Vol. 17. Р. 773–777.Lunz D., Philipp A., Judemann K. et al. First experience with the deltastream(R) DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-h ospital transport // Interact Cardiovasc. Thorac. Surg. 2013. Vol. 17. Р. 773–777.Rambaud J., Léger P. L., Larroquet M. et al. Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France // Intensive Care Med. 2016. Vol. 42. Р. 940–941.Rambaud J., Léger P. L., Larroquet M. et al. Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France // Intensive Care Med. 2016. Vol. 42. Р. 940–941.Rambaud J., Léger P. L., Porlier L. et al. International aircraft ECMO transportation: first French pediatric experience // Perfusion. 2017. Vol. 32. Р. 253–255.Rambaud J., Léger P. L., Porlier L. et al. International aircraft ECMO transportation: first French pediatric experience // Perfusion. 2017. Vol. 32. Р. 253–255.Wagner K., Sangolt G. K., Risnes I. et al. Transportation of critically ill patients on extracorporeal membrane oxygenation // Perfusion. 2008. Vol. 23. Р. 101–106.Wagner K., Sangolt G. K., Risnes I. et al. Transportation of critically ill patients on extracorporeal membrane oxygenation // Perfusion. 2008. Vol. 23. Р. 101–106.Mendes P.V., de Albuquerque G. C., Besen B. A.M.P. et al. Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature // Ann. Intensive Care. 2017. No 7. Р. 14.Mendes P.V., de Albuquerque G. C., Besen B. A.M.P. et al. Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature // Ann. Intensive Care. 2017. No 7. Р. 14.Labib A. Road transports on ECMO: The key elements // Qatar Medical Journal. 4th Annual ELSO-SWAC Conference Proceedings 2017. Р. 50.Labib A. Road transports on ECMO: The key elements // Qatar Medical Journal. 4th Annual ELSO-SWAC Conference Proceedings 2017. Р. 50.Lönnqvist P. A. Medical research and the ethics of medical treatments: disability-free survival // Br. J. Anaesth. 2017. Vol. 118. Р. 286–288.Lönnqvist P. A. Medical research and the ethics of medical treatments: disability-free survival // Br. J. Anaesth. 2017. Vol. 118. Р. 286–288.

The authors declare that there are no conflicts of interest present.