非醫學中心擔任區域葉克膜外接轉運及後送中心之經驗

Regional ECMO Transfer and Referral: Experience from a Non-Tertiary Center

葉克膜（ECMO）體外維生系統廣泛應用於治療複雜心肺衰竭的重症病況，但非所有醫院皆具備此項高難度醫療照護能力。因此，中小型醫院常需將需接受ECMO治療的患者轉運至醫學中心。本研究為回溯性分析，探討非醫學中心執行ECMO外接轉運的經驗，並評估轉運距離對患者臨床預後的影響。研究納入2013年至2022年間於研究醫院收治且接受院外ECMO治療後轉運至該院的42例患者。研究資料來自醫院ECMO資料庫，包含ECMO放置天數、ECMO類型（VA、VV、VVA）、脫離ECMO成功率、最終存活狀態及是否接受緊急心肺復甦術（ECPR）。轉運距離以Google地圖計算，並依據距離（≥20公里vs. <20公里）分組。結果顯示，ECMO放置天數（p=0.25）、ECMO類型（p=1.00）、存活率（p=0.61）及ECPR使用率（p=0.65）在兩組間無顯著差異。雖然短距離組的脫離ECMO成功率較高（p=0.69），但同樣未達統計顯著性。本研究受限於回溯性設計與樣本數影響，未來應納入更多臨床變數與前瞻性研究，以提供更全面的遠距ECMO轉運臨床建議。本回溯性研究顯示，外接ECMO轉運距離與多數臨床指標無顯著關聯。儘管<20公里組的脫離ECMO成功率有較高趨勢，但此結果需更多數據及前瞻性研究驗證。即便是資源條件有限的非醫學中心級醫院，只要是訓練有素的葉克膜外接團隊及加護病房團隊，都可以勝任院際葉克膜轉運，成為該地區的葉克膜後送中心。

Extracorporeal membrane oxygenation (ECMO) is widely used to treat complex cardiopulmonary failure; however, not all hospitals possess the capacity for this high-complexity procedure. Smaller hospitals frequently transfer patients requiring ECMO to tertiary centers for continued care. This retrospective study investigated the experience of a non-tertiary center in performing ECMO cannulation and transfers, evaluating the impact of transport distance on patient outcomes. Forty-two patients transferred to the study hospital after receiving ECMO cannulation at external facilities between 2013 and 2022 were included. Data, obtained from the hospital's ECMO database, included ECMO support duration, ECMO type (VA, VV, VVA), successful ECMO weaning rate, mortality, and emergency cardiopulmonary resuscitation (ECPR) use. Transport distance was calculated using Google Maps, and patients were grouped according to distance (≥20 km vs. <20 km).
Results showed no statistically significant difference between groups in ECMO support duration (p=0.25), ECMO type (p=1.00), mortality (p=0.61), or ECPR use (p=0.65). Although a higher successful ECMO weaning rate was observed in the shorter-distance group (p=0.69), this difference did not reach statistical significance. This study is limited by its retrospective design and sample size. Future prospective studies with larger sample sizes and incorporating additional clinical variables are warranted to provide more comprehensive recommendations for long-distance ECMO transfers.