Abstract
Amaç: Bu olguda Ekstrakorporeal Yaşam Desteği alan hasta naklinin hazırlık aşaması ve gerçekleştirilmesi esnasındaki tecrübelerin paylaşılması amaçlanmaktadır.
Olgu : Türkiye Yüksek İhtisas Hastanesinin, Ankara Şehir Hastanesine taşınması nedeniyle Ekstrakorporeal Yaşam Desteği (ECLS) almakta olan 39 Yaşında Glaskow Koma Skalası Skoru 15 olan, son dönem konjestif kalp yetmezliğine bağlı kalp transplantasyonunu bekleyen hasta, Ankara Şehir Hastanesine acil yardım ambulansları ile nakledilmiştir. Ekipte 2 adet Paramedik, Kalp ve Damar Cerrahisi Uzmanı, Anestezi ve Reanimasyon Uzmanı ve Ekstrakorporeal Membran Oksijenizasyonu (ECMO) cihazı teknisyeninden oluşturulması kararlaştırıldı. İki hastane arasındaki uygun rota belirlendi. Nakil öncesi ambulans donanımı uygun hale getirilerek simülasyon yapıldı, kullanılacak hasta taşıma asansör, kapılar belirlendi. Hastanın toplan nakil süresi 25 dakika, yolda geçirdiği süre 14 dakika saptandı. Nakil esnasında hastanın vital parametreleri stabil seyretti, komplikasyon veya cihazlarda bir problem yaşanmadı. Birçok ülkede farklı disiplinlerden konusunda uzman personelin yer aldığı ECMO transport sistemi oluşturulmuştur ve organizasyonu hastane öncesi sağlık sistemi tarafından gerçekleştirilmektedir. Ülkemizde profesyonel ECMO nakil ekipleri yoktur ve ECMO’lu hasta nakli konusunda hastane öncesi sağlık personellerine eğitimler verilmemektedir.
Sonuç : ECLS alan hasta nakli konusunun hastane öncesi personelin eğitim programlarına eklenmesi ve sadece ECLS alan hastaların nakli için standardize edilmiş ambulansların tasarlanması önerilmektedir.
References
- Merkle J, Djorjevic I, Sabashnikov A, el at. Mobile ECMO - A divine technology or bridge to nowhere? Expert Rev Med Devices. 2017; 14(10):821-831.
- Haydin, S., Ündar, A. Yasam destek sistemlerinin Dünya'daki gelismeleri ve Türkiye'deki son durum. Anadulu Kardiyoloji Dergisi: AKD, 13(6), 580.
- Dirnberger D. Fiser RT, Harvey C, et al. "Extracorporeal Life Support Organization (ELSO)." (2015).
- Hutin A, Abu-Habsa M, Burns B, et al. Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation. 2018; 130:44-48.
- Zonies D, Bein T, Phillip A, et al. VV-ECMO initiation and transport of NATO combat casualties from a war zone. Presented at the 1st Euro-ELSO Congress; 2012, Rome, Italy
- Broman, LM. Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems. J Thorac Dis. 2017; 9(9):3425-3429.
- Bryner B, Cooley E, Copenhaver W, et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation. Ann Thorac Surg. 2014; 98(4):1363-70.
Abstract
Aim: In this case, it is aimed to share experiences in the preparation and application stages of the transport of the patients receiving Extracorporeal Life Support (ECLS).
Case: A 36-year-old patient, who was receiving ECLS, who had a Glasgow Coma Scale (GCS) score of 15 and had heart transplantation due to end-stage congestive heart failure, was transferred from Yuksek İhtisas Training and Research Hospital to newly-opened Ankara City Hospital by Emergency Medical Services (EMS) ambulances.
The team was decided to consist of 2 Paramedics, 1 Cardiovascular Surgery Specialist, 1 Anesthesia and Reanimation Specialist and 1 Extracorporeal Membran Oxygenation (ECMO) device technician. The appropriate route between these two hospitals was determined. Prior to transport, ambulance equipment was adapted and simulated; Elevators, hospital doors to be used during transport were determined.
The total transport time was 25 minutes; The time spent on the road was 14 minutes. During the transport, the patient's vital parameters were stable, no complications, or device problems occurred. In many countries, the ECMO transport system has been created, including expert professionals from different disciplines, and the organization of this system is carried out by the EMS Administration. There are no professional ECMO transport teams in our Turkey, and EMS professionals are not trained on transporting patients with ECMO.
Conclusion: It is recommended that the transport of the patients with ECLS be added to the training programs of EMS professionals and design of ambulances specific to the transport of these patients.
References
- Merkle J, Djorjevic I, Sabashnikov A, el at. Mobile ECMO - A divine technology or bridge to nowhere? Expert Rev Med Devices. 2017; 14(10):821-831.
- Haydin, S., Ündar, A. Yasam destek sistemlerinin Dünya'daki gelismeleri ve Türkiye'deki son durum. Anadulu Kardiyoloji Dergisi: AKD, 13(6), 580.
- Dirnberger D. Fiser RT, Harvey C, et al. "Extracorporeal Life Support Organization (ELSO)." (2015).
- Hutin A, Abu-Habsa M, Burns B, et al. Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation. 2018; 130:44-48.
- Zonies D, Bein T, Phillip A, et al. VV-ECMO initiation and transport of NATO combat casualties from a war zone. Presented at the 1st Euro-ELSO Congress; 2012, Rome, Italy
- Broman, LM. Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems. J Thorac Dis. 2017; 9(9):3425-3429.
- Bryner B, Cooley E, Copenhaver W, et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation. Ann Thorac Surg. 2014; 98(4):1363-70.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | June 30, 2020 |
| Published in Issue | Year 2020 Volume: 3 Issue: 2 |
