Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 38(4): 254-261 (2022)

症例報告Case Report

小児心疾患患者における開胸下ECMOの長距離陸路搬送の経験Mobile ECMO for Long Distance Ground Transport in a Pediatric Cardiac Patient with Central VA-ECMO in Japan

1東京都立小児総合医療センター麻酔科臨床工学技士室Clinical Engineering, Tokyo Metropolitan Children’s Medical Center ◇ Tokyo, Japan

2東京都立小児総合医療センター救命・集中治療部 集中治療科Critical Care and Emergency Medicine, Tokyo Metropolitan Children’s Medical Center ◇ Tokyo, Japan

3東京都立小児総合医療センター心臓血管外科Cardiovascular Surgery, Tokyo Metropolitan Children’s Medical Center ◇ Tokyo, Japan

受付日:2022年7月5日Received: July 5, 2022
受理日:2022年11月2日Accepted: November 2, 2022
発行日:2022年12月1日Published: December 1, 2022

我々はVA-ECMOから離脱困難となった虚血性心筋症の小児例に対し,開胸下で520 km, 10時間に及ぶ長距離の陸路ECMO搬送を経験したので報告する.搬送車両は当院独自のドクターカーを用い,事前に搬送中の各医療機器の消費電力と酸素消費量を概算し準備を行った.また搬送中のECMOカニューレの事故抜去を防ぐため,搬送前日に送血部位を大動脈基部より右総頚動脈に変更し,脱血カニューレは右房からより深めに留置,厳重な固定を行った.必要な資機材がすべて1枚のバックボードに収まるように医療機器とともに患児を固定し,ドクターカー内に収容した.搬送チームは,実働時間を加味し2チーム交代制とした.重大な有害事象なく搬送を終えることができた.ECMO搬送では,医療機器のトラブルやカニューレの事故抜去は致死的である.特に小児の開胸下ECMOでは,搬送中の振動によりカニューレ事故抜去のリスクがより高まる.搬送手段や所要時間に応じ搬送中の安全を考慮した事前準備とチーム編成が肝要である.また,本邦では小児ECMO搬送は少なく,症例を集積し搬送システムの定型化が急務である.

A 3-year-old, female patient required venous-arterial extracorporeal membrane oxygenation (VA-ECMO) for ischemic cardiomyopathy. Conversion from ECMO to a ventricular assist device was needed due to failure to wean from ECMO. The patient was therefore transported to another hospital 520 km away via ground transport. We used our own ambulance which was specially equipped for pediatric ECMO transportation. Estimation of the total electricity and oxygen consumption during transportation indicated that these were well within safety parameters. On the day prior to transport, the perfusion cannula site was moved from the ascending aorta to the right common carotid artery, and the depth of the drainage cannula was increased to minimize the risk of accidental dislodgement. The patient was secured, along with the medical equipment, onto a single backboard in the ambulance. The transport team was divided into two groups to monitor the patient in shifts. The patient was transported without any adverse events. Precautions should be taken to avoid potentially life-threatening but preventable events such as difficulties with medical equipment and accidental dislodgement of ECMO cannulas. Pediatric ECMO has a particularly high risk of accidental cannula dislodgement during transport due to vibrations and acceleration. It is important to prepare for these contingencies and to assemble a team capable of responding to them. Since there are few pediatric ECMO cases in Japan, more data is urgently needed to standardize the transport process.

Key words: mobile extracorporeal membrane oxygenation; ground transport; central cannulation; veno-arterial extracorporeal membrane oxygenation; pediatric cardiac patient

This page was created on 2022-12-26T10:14:34.944+09:00
This page was last modified on 2023-02-21T18:06:42.000+09:00