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. Due to expanded clinical indications, improved patient outcomes, and advancements in related technologies, ECMO的使用在过去十年中显著增加, with over 260 hospitals in the US now offering ECMO.[1]
While ECMO is not a new clinical therapy, 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. In light of this, cardiovascular (CV) leaders need to consider whether mobilizing their ECMO program would serve as an effective way to grow MCS volumes, expand care geographically, and strengthen CV partnerships.
Notable Trends in Mobile ECMO
- More Compact Equipment: 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, including during transport between care facilities.
- Dedicated Transport Teams and Protocols: 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.
- Ambulance 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.
- Integration of Telemedicine and Remote Support: 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, thereby enabling more efficient and timely care.
- Expanded Indications: 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.
- Improved Training and Education: As the use of mobile ECMO becomes more widespread, 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, such as during transportation or in the field.
Building the Necessary Partnerships
An important component of ECMO mobilization is establishing community or regional partnerships to provide ECMO transport via a hub-and-spoke model, as illustrated in figure 1. 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]
As shown in figure 2, 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, leading to more coordinated and efficient care, better patient outcomes, improved resource allocation, 以及ECMO专业知识和管理的持续进步.
Figure 1: ECMO Hub-and-Spoke Transportation Model
Figure 2: 医院ECMO容量与死亡率的风险调整关系[3]
When developing these essential network partnerships, 医院和bet8网站备用将需要确保适当的运输和转移协议, as well as provider credentialing, are in place.
- Transport Agreement: Referring and accepting hospitals will need to establish a transport agreement detailing the responsibilities, liabilities, and performance standards for each party.
- Transfer Agreements: Referring and accepting hospitals will need to establish a transfer agreement documenting the parties’ agreement to transport patients between their facilities.
- Provider Credentialing: 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, additional training, 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, both of which are vital to the success of the program.
Developing a Best-in-Class Program
When developing a mobile ECMO program, 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.
- A multistate operation, 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. If you are serving local health systems, an ambulance would be a sufficient mode of transportation; however, if you are servicing systems in multiple states, 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.
Once a network of care has been established, 现在是开始处理病人转运请求的时候了. Programs typically choose between using a call center, 代理收集患者信息,然后将呼叫转移给随叫随到的提供者, or a direct call number, where calls route directly to the on-call provider. In both cases, if a patient is a candidate for mobile 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. Therefore, 最好的做法是直接呼叫值班bet8网站备用或项目经理, as it enables quick and accurate decision-making, especially if inclusion criteria is shared ahead of time with the referring organization and sufficient education. Distributing mobile ECMO program details via flyers, informational emails, conferences and other professional events, 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. Buy-in is needed in order to:
- Build and maintain collaborative relationships with various clinical and nonclinical hospital departments.
- 确保所有行政要求按时完成.
- Develop and sustain a thorough training program.
- 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.
Select Program Characteristics
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.
Table 1: Select Mobile ECMO Programs and Characteristics
So Should You Go Mobile? A Summary of Considerations for Leadership
When deciding whether to offer a mobile ECMO program, 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. To do so, 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, successful programs.
Table 2: ELSO关于建立移动ECMO计划的五大考虑因素
In addition to the above recommendations from ELSO, 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. The ECMO program’s quaternary reputation, market share, and ability to grow MCS case volume are all factors that will contribute to a healthy and sustainable program.
As the use and demand for ECMO increases, 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.
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Edited by: Emily Johnson
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2 Abrams, D., Garan, A.R., Abdelbary, A. et al., “成人心力衰竭ECMO方案的组织立场文件,” Intensive Care Med, February 2018.
3 Verma, A., Hadaya, MD, PhD, J., et al., “A contemporary analysis of the volume–outcome relationship for extracorporeal membrane oxygenation in the United States,” Surgery, June 2023.
4 “First-of-its-kind medical truck launches in the Twin Cities metro to treat cardiac arrest patients,” February 3, 2021 News Release, University of Minnesota.
5 “COVID - 19大流行期间向地区医院提供移动生命支持,” From the Newsroom, UC San Diego Health. “Elements of a Comprehensive ECMO Program,” UC San Diego Health.
6 “About Our Mobile ECMO Transport Team,” NewYork-Presbyterian website.
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,” Penn Medicine Physician Blog.
8 “移动ECMO可将危重病人转移到霍普金斯大学,” News & Publications, Johns Hopkins Medicine.
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