Extracorporeal membrane oxygenation (ECMO) is a life-saving medical therapy that provides temporary mechanical circulatory support (MCS) for patients with severe heart or lung failure. 由于扩大临床适应症, 改善患者预后, 以及相关技术的进步, ECMO的使用在过去十年中显著增加, 目前美国有260多家医院提供体外膜肺氧合.[1]
ECMO并不是一种新的临床治疗方法, 动员这种bet8娱乐的概念似乎是第四纪计划的新兴趋势. Mobile ECMO offers access to advanced care for patients during transportation and those in resource-limited areas while increasing the patient volume for ECMO centers. 鉴于此, cardiovascular (CV) leaders need to consider whether mobilizing their ECMO program would serve as an effective way to grow MCS volumes, 在地理上扩大护理, 加强CV伙伴关系.
移动ECMO的显著趋势
- 更紧凑的设备: Advancements in technology have led to the development of more compact and portable ECMO machines. These smaller devices make it easier for healthcare providers to supply ECMO support to patients outside of traditional hospital settings, 包括在护理机构之间的运输过程中.
- 专门的运输小组和协议: Healthcare systems that offer mobile ECMO often have a dedicated ECMO transport team with the expertise to safely move critically ill patients on ECMO from one facility to another. These systems have also developed standardized protocols for transport to ensure patient safety during this process.
- 救护车ECMO: Some health systems are establishing partnerships with ambulance companies in order to equip these vehicles with ECMO so that MCS can be initiated on site or during transportation to a tertiary or quaternary medical center. This added capability can potentially improve outcomes for patients in critical condition who require ECMO immediately.
- 远程医疗与远程支持的整合: Telemedicine and remote-monitoring technologies can be integrated into mobile ECMO programs to allow ECMO specialists to provide guidance and support to healthcare teams at different facilities, 从而实现更有效和及时的护理.
- 扩大适应症: 随着时间的推移，启动移动ECMO支持的标准已经扩大. As a result of increased experience and research—due in large part to the use of ECMO during the COVID‑19 pandemic—ECMO is now used for various respiratory and cardiac conditions that were previously deemed unsuitable.
- 改进培训和教育: 随着移动ECMO的使用越来越广泛, provider organizations are offering specialized training and education for healthcare professionals involved in ECMO services. 这通常包括跨学科和基于模拟的活动, 使临床bet8网站备用能够在各种情况下实践ECMO管理技能, 例如在运输过程中或在野外.
建立必要的伙伴关系
An important component of ECMO mobilization is establishing community or regional partnerships to provide ECMO transport via a hub-and-spoke model, 如图1所示. 而维持ECMO中心所需的每年ECMO病例的最低数量经常存在争议, various studies conclude that an inverse linear relationship between mortality rate and volume exists, 建议的最低年度病例数为30例.[2]
如图2所示, 较大容量的ECMO中心可能降低死亡率并改善预后. 区域伙伴关系可以支持将患者集中到一个地点, 导致更加协调和有效的护理, 更好的患者预后, 改善资源分配, 以及ECMO专业知识和管理的持续进步.
图1: ECMO轮辐运输模型
图2: 医院ECMO容量与死亡率的风险调整关系[3]
在发展这些重要的网络伙伴关系时, 医院和bet8网站备用将需要确保适当的运输和转移协议, 以及提供商认证, 都就位了.
- 运输协议: Referring and accepting hospitals will need to establish a transport agreement detailing the responsibilities, 负债, 以及各方的绩效标准.
- 转让协议: Referring and accepting hospitals will need to establish a transfer agreement documenting the parties’ agreement to transport patients between their facilities.
- 供应商资格审查: Care team members will need to be credentialed at all community partner facilities where they could provide ECMO services.
如果你的组织没有负责地面或空中运输的内部部门, 你还需要与一家可靠的运输公司合作. 由于在空中操作ECMO需要额外的风险和培训, it is especially critical to find a service provider that excels in aircraft maintenance and is willing to comply with any necessary rig modifications, 额外的培训, 以及与移动ECMO项目相关的操作指南. Establishing close partnerships with local companies will enable a quick response time while ensuring a high level of trust for the ECMO team, 这两点对项目的成功至关重要.
开发一流的课程
在开发移动ECMO程序时, 首先确定你想要bet8娱乐的地理区域, as the location and reach of the program will generate associated requirements and considerations.
- 多状态操作, 尤其是那些打算与非附属医疗机构合作的人, requires additional up-front work to ensure appropriate provider credentialing is obtained and maintained by all physicians participating in the program.
- 项目的地理范围也决定了所需的交通方式. 如果你在为当地bet8网站备用bet8娱乐, an ambulance would be a sufficient mode of transportation; however, 如果您在多个州为系统提供bet8娱乐, 你可能需要考虑直升飞机或固定翼飞机.
- 最后，考虑与病人运输相关的报销问题. 如果在转诊医院和家庭组织之间有ECMO中心, CMS可能不会报销从该中心到家庭医院的距离. 战略性的市场选择是避免这些不利因素的关键.
一旦建立了护理网络, 现在是开始处理病人转运请求的时候了. 程序通常会在使用呼叫中心之间做出选择, 代理收集患者信息，然后将呼叫转移给随叫随到的提供者, 或者直拨电话号码, 在哪里呼叫直接路由到随叫随到的提供者. 这两种情况, 患者是否适合进行移动ECMO, 将启动流动ECMO小组，对患者进行治疗并将其运送回医院.
由于患者需要ECMO干预的急迫性, 尽量减少筛选所需的步骤可以拓宽成功之路. 因此, 最好的做法是直接呼叫值班bet8网站备用或项目经理, 因为它可以快速准确地做出决策, especially if inclusion criteria is shared ahead of time with the referring organization and sufficient education. 通过传单分发移动ECMO项目细节, 信息的电子邮件, 会议和其他专业活动, and even direct provider networking will help advertise the program and shorten the lead time from patient identification to mobile ECMO intervention.
来自组织领导的支持也是项目成功的重要组成部分. 为了:
- Build and maintain collaborative relationships with various clinical and nonclinical hospital departments.
- 确保所有行政要求按时完成.
- 制定并维持全面的培训计划.
- Effectively partner with external transportation companies and healthcare organizations to support the network.
企业级目标设置和计划管理工作将是至关重要的, 特别是在项目的早期阶段，不可避免地会经历成长的烦恼.
选择项目特点
根据患者的需求，移动ECMO方案因组织而异. 表1说明了全国各地选择的移动ECMO项目的关键特征, 哪些可能对正在考虑动员其ECMO项目的领导人有所帮助.
表1: 选择移动ECMO程序和特性
所以你应该转向移动设备吗? 对领导力的考虑总结
在决定是否提供移动ECMO方案时, 系统领导者必须确保他们能够提供这里讨论的所有必需元素. 这样做, 参考最近出版的体外生命支持组织(ELSO)指南, 哪些概述了所有高质量的五个关键组成部分, 成功的项目.
表2: ELSO关于建立移动ECMO计划的五大考虑因素
除了以上来自ELSO的建议之外, ECMO项目负责人必须仔细管理项目的财务可行性, which will include developing a network that supports the level of programmatic volume necessary to generate a positive return on investment. ECMO项目的四级声誉, 市场份额, and ability to grow MCS case volume are all factors that will contribute to a healthy and sustainable program.
随着ECMO的使用和需求的增加, 现有项目可能会考虑是否提供ECMO运输. 成功的移动ECMO方案优先考虑患者安全和操作. 提供移动ECMO的决定必须经过深思熟虑, with program leaders carefully evaluating the value this life-saving care provides to patients versus the costs and resources required to start and maintain a program of this caliber.
心电图的CV咨询团队对改善CV护理bet8娱乐充满热情. Since 2010, team members have conducted nearly 300 CV engagements across more than 100 organizations. 我们的专家专注于为全国领先的简历项目提供执行咨询bet8娱乐.
编辑: 艾米丽约翰逊
_________________________
1 Stentz MJ, Kelley ME, Jabaley CS, O'Reilly-Shah V, Groff RF, Moll V, Blum JM， "美国体外膜氧合的发展趋势《bet8网站备用》，2019年9月/ 10月.
艾布拉姆斯，D.加兰，A.R.A . Abdelbary. 等., “成人心力衰竭ECMO方案的组织立场文件,” 重症监护2018年2月.
3 Verma, A.， Hadaya, MD, PhD, J.等。., “A contemporary analysis of the volume–outcome relationship for extracorporeal membrane oxygenation in the United States,” 手术, 2023年6月.
4 “First-of-its-kind medical truck launches in the Twin Cities metro to treat cardiac arrest patients， 2021年2月3日，明尼苏达大学新闻发布.
5 “COVID - 19大流行期间向地区医院提供移动生命支持来自加州大学圣地亚哥分校健康中心的新闻编辑室. “全面ECMO计划的要素加州大学圣地亚哥分校健康中心.
6 “bet8娱乐的移动ECMO运输团队，纽约长老会网站.
7 “宾夕法尼亚大学医学院移动ECMO:一项针对高危心脏和呼吸系统患者的动态计划宾夕法尼亚大学医学院医师博客.
8 “移动ECMO可将危重病人转移到霍普金斯大学,“新闻 & 出版，约翰霍普金斯医学.
9“Extracorporeal Life Support Organization Guideline for Transport and Retrieval of Adult and Pediatric Patients with ECMO Support,” ASAIO杂志, 2022.
