Objectives: 

To describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation to a regional pediatric intensive care transport service, and identify clinical features at initial referral that predict the eventual need for extracorporeal membrane oxygenation.

Design: 

Retrospective analysis of prospectively collected data.

Setting: 

Specialist pediatric intensive care transport service based at a large U.K. extracorporeal membrane oxygenation center.

Patients: 

All referrals made for potential extracorporeal membrane oxygenation transport between January 2014 and July 2017.

Interventions: 

None.

Measurements and Main Results: 

Demographic and clinical data at the time of referral, referral outcome, and 90-day mortality status were extracted. Univariate and multivariate analyses were used to identify clinical features at initial referral in neonates that predicted the need for extracorporeal membrane oxygenation. Of 253 extracorporeal membrane oxygenation referrals, 203 were included: 64 of 203 received extracorporeal membrane oxygenation (31.5%), 18 were accepted for extracorporeal membrane oxygenation but died before extracorporeal membrane oxygenation could be provided (8.8%), and 121 did not receive extracorporeal membrane oxygenation (59.6%). The transport team mobilized in 136 of 203 referrals (66.9%); conventional transport to an extracorporeal membrane oxygenation center was successful in 127 of 136 (93.4%), while nine of 136 were too unstable to transport. The 90-day mortality for the cohort was 17.7% (36/203). In logistic regression analysis, the odds ratio of requiring extracorporeal membrane oxygenation for diaphragmatic hernia was 12.0 (95% CI, 2.8–52.1) compared to meconium aspiration syndrome. Oxygenation index and Vasoactive-Inotropic Score were independent predictors of the need for extracorporeal membrane oxygenation in neonates.

Conclusions: 

In this large cohort of neonatal and pediatric extracorporeal membrane oxygenation referrals to a pediatric intensive care transport service, a considerable portion of extracorporeal membrane oxygenation referrals (59.6%) continued on conventional management; however, 8.8% of the referrals died before extracorporeal membrane oxygenation could be provided. Earlier referral for extracorporeal membrane oxygenation; targeted referral triage using primary diagnosis, oxygenation index, and Vasoactive-Inotropic Score; and access to mobile extracorporeal membrane oxygenation services and faster mobilization of transport teams are important factors that could improve outcomes.

中文翻译：

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新生儿，婴儿和儿童的临床特征和结果转介至区域性儿科重症监护运输服务以进行体外膜氧合*

目标： 

为了描述转诊至区域小儿重症监护运输服务的体外膜氧合的临床特征和转归，并确定初次转诊时可预测最终需要进行体外膜氧合的临床特征。

设计： 

回顾性分析预期收集的数据。

设置： 

位于英国大型体外膜氧合作用中心的专科儿科重症监护运输服务。

耐心： 

在2014年1月至2017年7月之间进行了所有可能的体外膜氧合运输的转诊。

干预措施： 

没有。

测量和主要结果： 

提取了转诊时的人口统计学和临床​​数据，转诊结局和90天死亡率。单因素和多因素分析用于确定新生儿初次转诊时的临床特征，这些特征预示了需要进行体外膜氧合。在253个体外膜氧合转诊中，包括203个：203个中的64个接受了体外膜氧合（31.5％），接受了18个体外膜氧合但在可提供体外膜氧合前死亡（8.8％），有121个未接受体外氧合膜氧合（59.6％）。运输小组动员了203个推荐中的136个（66.9％）；常规运输到体外膜氧合中心的成功率为136的127（93.4％），而136的运输中有9太不稳定。该队列的90天死亡率为17.7％（36/203）。在逻辑回归分析中，与胎粪吸入综合征相比，diaphragm肌疝需要体外膜充氧的几率是12.0（95％CI，2.8-52.1）。氧合指数和血管活性肌力评分是新生儿体外膜氧合需要的独立预测因子。

结论： 

在这一由新生儿和小儿体外膜氧合转诊至小儿重症监护运输服务的大型队列中，相当一部分常规常规管理继续进行了体外膜氧合转诊（59.6％）。但是，有8.8％的转诊者在可以提供体外膜氧合之前死亡。尽早转诊体外膜氧合；使用初步诊断，氧合指数和血管活性-肌力评分进行有针对性的转诊分类；以及获得可移动的体外膜氧合作用以及更快地动员运输团队是可以改善结果的重要因素。