【摘要】 目的调查浙江省县区级及以上的综合性医院急诊科开展体外膜肺氧合(ECMO)技术的情况。方法采用横断面调查性研究,由浙江省急诊医学质量控制中心发起,组织专家制定调查表,纳入浙江省县区级第一人民医院及以上的综合性公立医院,调查内容包含医院的概况、ECMO配置情况、全院及急诊科ECMO开展情况,以及在开展ECMO时遇到的困难及对质控、培训的态度和要求。通过省、地市、县区三级急诊质控网络落实调查表的发放与回收、核对。结果 (1)最终纳入全省11个地市的114家医院,占目标医院总数的94.2%;54家医院(47.4%)开展ECMO,其中34家(29.8%)能独立开展;25家医院的急诊科(21.9%)开展ECMO,其中17家(14.9%)能独立开展。(2)2019年全省急诊科开展128例ECMO(占全省总数669例的19.1%),其中省级医院为53例(占41.4%),其次为台州市(30例,23.4%)、嘉兴市(12例,9.4%)。静脉-静脉体外膜肺氧合(V-V ECMO) 26例(20.3%),静脉-动脉体外膜肺氧合(V-A ECMO)102例(79.7%),含体外心肺复苏(ECPR)65例(50.8%),V-A ECMO及ECPR的比例高于全省(79.7%vs.68.5%,P=0.011;50.8%vs.19.1%,P<0.05)。(3)急诊科开展ECMO的成功撤机率为51.6%,患者存活率为38.3%,与2020年世界总体的ECMO标化撤机率(51.5%,P=1.000)、患者存活率(39.4%,P=0.898)差异无统计学意义(P>0.05)。(4)93.8%和95.5%的调查对象认为ECMO对医院、学科发展和危重患者救治的作用大或很大;83.9%和83.0%的医院对ECMO的培训、质控有需求。结论 ECMO技术在浙江省县区级及以上医院的急诊科有一定的开展,但地区间的差异较大;ECMO在急诊主要用于循环支持和心肺复苏(CPR);需要进一步加强急诊ECMO的培训与质控。更多还原

【Abstract】 Objective To investigate the implementation of extracorporeal membrane pulmonary oxygenation(ECMO) technology in the emergency departments of general hospitals at the county and district levels and above in Zhejiang province. Methods A cross-sectional survey study was conducted, initiated by the Quality Control Center of Emergency Medicine of Zhejiang province, and the experts were organized to develop a questionnaire about general public hospitals of the first people′s hospital(excluding Chinese medicine hospitals) and above at the county and district levels in Zhejiang province. The survey included hospital overview, the configuration of ECMO, the development of ECMO in the emergency department and the whole hospital, and the difficulties encountered in the development of ECMO, and attitudes and requirements for quality control and training. The questionnaires were distributed, collected and verified through the three-level emergency care quality control network of the province, local cities and counties. Results(1)114 hospitals in 11 localities and cities in the province were finally included, accounting for 94.2% of the total number of target hospitals; 54 hospitals(47.4%) carried out ECMO, of which 34 hospitals(29.8%) could do so independently; 25 hospitals′ emergency departments(21.9%) carried out ECMO, of which 17(14.9%) could do so independently.(2)In 2019, ECMO were carried out for 128 cases in emergency departments in the province(19.1% of the total 669 cases in the province), including 53 cases(41.4%) in provincial hospitals, followed by Taizhou region(30 cases, 23.4%) and Jiaxing region(12 cases, 9.4%). 26 cases(20.3%) accepted veno-venous extracorporeal membrane pulmonary oxygenation(V-V ECMO), 102 cases(79.7%) veno-arterial extracorporeal membrane pulmonary oxygenation(V-A ECMO), including 65 cases(50.8%) extracorporeal cardiopulmonary resuscitation(ECPR), and the proportions of V-A ECMO and ECPR were higher than those of the province(79.7% vs. 68.5%, P=0.011; 50.8% vs. 19.1%, P<0.05).(3)The successful weaning rate of ECMO performed in the emergency department was 51.6% and the patient survival rate was 38.3%, which was not different from the overall world standardized ECMO weaning rate(51.5%, P=1.000) and the patient survival rate(39.4%, P=0.898) in 2020 according to ESLO.(4)93.8% and 95.5% of the survey respondents believed that ECMO was useful or very useful for hospital, discipline development and critical patient care; 83.9% and 83.0% of the hospitals had a need for ECMO training and quality control. Conclusions ECMO is carried out in the emergency departments of hospitals at the county and district level and above in Zhejiang province, but there are significant differences between regions; ECMO is mainly used for circulatory support and cardiopulmonary resuscitation in emergency medicine; training and quality control of ECMO in emergency medicine need to be further strengthened.更多还原