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10 August 2023, Volume 4 Issue 8 Previous Issue    Next Issue

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Construction and validation of risk prediction model for iatrogenic femoral artery pseudoaneurysm after transcatheter radiofrequency ablation CHEN Jieying, ZHAO Fei 2023, 4 (8):  677-682.  doi: 10.3761/j.issn.2096-7446.2023.08.001 Abstract ( 206 )   Save Objective To construct a risk prediction model for iatrogenic femoral pseudoaneurysm （IPA） after transcatheter radiofrequency ablation，and to explore the effect of the model. Methods The clinical data of patients with arrhythmia who underwent transcatheter radiofrequency ablation from August 1，2018 to February 28，2023 in the cardiovascular department of a tertiary grade-A hospital in Zhejiang Province were retrospectively collected. 50 patients with postoperative IPA were selected as the case group，while 204 patients without IPA were randomly selected as the control group. Risk factors were analyzed and a nomogram prediction model was constructed. Independent risk factors were determined by multiple Logistic regression analysis（stepwise forward method）. Hosmer-Lemeshow test was used for goodness of fit of the model. Results Logistic regression analysis showed that age（OR =1.061），catheter type≥（OR =9.716），and postoperative international standardized ratio （OR =8.982） were independent risk factors for IPA. Local compression time（OR=0.051），compression dressing time（OR=0.846） and limb immobilization time（OR=0.605） were protective factors. The area under ROC curve of the nomogram model was 0.906（95%CI=0.848~0.964，P<0.001），the sensitivity was 0.860，and the specificity was 0.759. The area under ROC curve of the externally validated model was 0.868（95%CI=0.760~0.976，P<0.001）. Conclusion The iatrogenic femoral pseudoaneurysm nomogram model established in this study has good predictive efficacy，which can provide a basis for clinical staff to formulate hierarchical management strategies and reduce the risk of its occurrence. Related Articles | Metrics

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Construction of a protocol for prevention of lower limb ischemia in patients with venous-arterial extracorporeal membrane oxygenation XUAN Jiling, DAI Weiying, YANG Xiangying, YE Weiguo, LIN Yao, XIA Liuqin, ZENG Xiaokang 2023, 4 (8):  683-688.  doi: 10.3761/j.issn.2096-7446.2023.08.002 Abstract ( 195 )   Save Objective To construct a scheme for prevention of lower limb ischemia in patients with venous-arte- rial extracorporeal membrane oxygenation，which can further reduce the occurrence of lower limb ischemia and iden- tify the occurrence of lower limb ischemia in the early stage，so as to shorten the time of ischemic complications and improve the quality of life. Methods To construct literature review on the venous-arterial extracorporeal mem- brane oxygenation related lower limb ischemia prevention program，20 experts were queried twice using the Delphi method to form the final plan for the prevention of lower limb ischemia in patients with venous-arterial extracorpo- real membrane oxygenation. Results The response rates of the two rounds of expert consultation were 100%，the authority coefficients were 0.83 and 0.87，and the variation coefficients of each item of the two rounds of expert consultation were 0.05-0.12 and 0.07-0.21，respectively，Kendall’s harmonic coefficients were 0.121（χ2=89.798，P<0.001） and 0.193 （χ2=141.308，P<0.001），respectively. Finally，a 4-dimensional，26-item venous-arterial extracorporeal mem- brane oxygenation related lower limb ischemia prevention protocol was formed. Conclusion The prevention protocol for venous-arterial extracorporeal membrane oxygenation related lower limb ischemia is scientific and feasible. It can reduce the occurrence of lower limb ischemia and promote the early recognition of lower limb ischemia，to ensure the quality of life of patients. Related Articles | Metrics

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Application of progressive rehabilitation exercise in patients with mechanical ventilation in ICU BIAN Hong, YU Ping, SUN Qin, HE Ping 2023, 4 (8):  689-694.  doi: 10.3761/j.issn.2096-7446.2023.08.003 Abstract ( 242 )   Save Objective To investigate the effect of progressive rehabilitation exercise in patients with mechanical ventilation in ICU. Methods A total of 80 patients receiving mechanical ventilation treatment in two wards of ICU of a tertiary Grade A hospital in Wuxi of Jiangsu Province from January 2021 to June 2022 were selected for this study. By unit convenience sampling method，they were divided into two groups，with 40 cases in each group. The control group received routine rehabilitation exercise nursing. The experimental group received early rehabilitation exercise through progressive rehabilitation exercise. Grip strength，sleep quality score，mechanical ventilation duration，length of stay in ICU，incidence of ICU acquired weakness （ICU-AW） and adverse events were compared between the two groups. Results Two patients in the experimental group and six patients in the control group withdrew midway，so 38 patients in the experimental group and 34 patients in the control group were retained. The grip strength and sleep quality score of the experimental group were higher than those of the control group， mechanical ventilation duration，ICU stay length and the incidence of ICU-AW of the experimental group were lower than those of the control group （P<0.05）. During the implementation of the study，there were no adverse events caused by rehabilitation training in the experimental group. Conclusion Progressive rehabilitation exercise can increase the grip strength of patients with mechanical ventilation in ICU，promote the recovery of body function， prevent the occurrence of ICU-AW，regulate the sleep quality of patients，and shorten the length of stay in ICU. Related Articles | Metrics

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Effect of early resistance training on success of ventilator offline in patients with severe respiratory diseases LIU Yue, WANG Lin, YUAN Yuan, WANG Ting 2023, 4 (8):  695-699.  doi: 10.3761/j.issn.2096-7446.2023.08.004 Abstract ( 212 )   Save Objective To investigate the effects of early resistance training on the success rate of ventilator weaning，off-line efficiency and activity ability in patients with severe respiratory diseases，and to provide guidance for the early rehabilitation of patients with severe respiratory diseases. Methods We selected 64 patients who were admitted to Intensive Care Unit of Respiratory Department of our hospital and received mechanical ventilation from January 2019 to January 2020 as study subjects，and were randomly divided into experimental group and control group with 32 patients in each group. The control group received routine nursing，and the experimental group received early resistance weaning training program led by nurses. The differences of offline success rate，offline efficiency and activity ability after intervention were compared between the two groups. Results After the early resistance off-line training，the success rate of the experimental group was significantly higher than that of the control group （90.63% vs. 65.63%，P=0.015），the duration of ventilator use was significantly lower than that of the control group [（10.80±2.20） d vs.（14.00±3.50） d，P=0.028］，and the incidence of complications was lower（43.75% vs. 68.75%，P=0.014）. The activity ability of experimental group on day 1 and day 3 after offline was significantly better than that of control group（P<0.001）. Conclusion Early resistance off-line training can improve the success rate and off-line efficiency of severe patients，improve the activity level of patients，and promote their disease rehabilitation. Related Articles | Metrics

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Design and application of antiskid counting grip dynamometer for ICU mechanically ventilated patients PENG Qiaoqiao, YANG Xiangying, ZENG Xiaokang 2023, 4 (8):  700-703.  doi: 10.3761/j.issn.2096-7446.2023.08.005 Abstract ( 139 )   Save Objective To investigate the application effect of self-made anti-skid counting grip dynamometer in grip strength exercise in ICU mechanically ventilated patients. Methods Anti-skid counting grip dynamometer consists of grip ball，gloves，flashing light，counter，convex ball，conductive rubber rod，convex particle and so on. 50 patients with mechanical ventilation from the Department of Critical Care Medicine of a tertiary hospital in Hangzhou from June to August 2022 were selected as application objects，and divided into control group and experimental group by the random number table method. 25 patients were in each group. The experimental group used the anti-skid counting grip dynamometer，and the control group used the traditional grip ball. The grip exercise compliance，grip strength，muscle strength of upper limbs，slippage times of grip balls and patient satisfaction were compared between two groups. Results The compliance of the experimental group was 96% which was higher than that in the control group （48%），and the difference was statistically significant （Z=-4.65，P< 0.05）. The increase of grip strength，muscle strength，and patient satisfaction in the experimental group were significantly higher than those in the control group （P<0.05）. The average slip times of the grip ball in the control group was 2.48 times，and there was no slip in the experimental group. Conclusion The application of anti-skid counting grip dynamometer in ICU mechanically ventilated patients can improve their compliance with grip strength exercise，thereby increasing their grip strength and muscle strength，and their satisfaction. Related Articles | Metrics

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Evidence summary of ICU early rehabilitation in bed for patients after cardiac valve replacement WANG Danhua, CHEN Jin, LIU Haiying, HUANG Dongxue, LI Xuguang, GAO Yan, YUAN Zhifang, LIN Mei, SHEN Yuehao 2023, 4 (8):  704-710.  doi: 10.3761/j.issn.2096-7446.2023.08.006 Abstract ( 229 )   Save Objective To retrieve the relevant evidence for ICU early rehabilitation in bed for patients after cardiac valve replacement，and to provide a guidance for ICU early rehabilitation for patients in bed. Methods A computer search was performed on BMJ Best Practice，UpToDate，Joanna Briggs Institute library，Cochrane Library， Registered Nurses’ Association of Ontario（RNAO），Scottish Intercollegiate Guidelines Network （SIGN），National Insti- tute for Health and Care Excellence （NICE），WHO，Clinical guideline，American College of Cardiology，European As- sociation for Cardiothoracic Surgery，Web of Science，PubMed，Chinese Biomedical Literature Database，China Knowl- edge Infrastructure，Wanfang Database，and VIP Database on early rehabilitation in patients after cardiac valve re- placement，including clinical decision-making，guidelines，expert consensus，systematic review，evidence summary，primary research. The retrial period was from database establishment to March，2023. Two researchers with master’s degree and evidence-based knowledge evaluated the quality of the literatures，and then extracted and summarized the evidence. Results A total of 9 articles were included，including one clinical decision-making，three guidelines， one expert consensuses，one systematic review，two randomized control trials and one evidence summary. The best evidence included 18 recommendations in 7 aspects，multidisciplinary participation，pre-rehabilitation assessment，exercise training，individual massage，respiratory training，dynamic assessment and health education. Conclusion Our re- search summarized the best evidence of ICU early rehabilitation in bed for patients after cardiac valve replacement. The medical staff should apply evidence selectively according to the current situation of the department and the patients to construct the early rehabilitation program for the patients in bed，so as to promote postoperative early rehabilitation. Related Articles | Metrics

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Progress in the application of peer support in the rehabilitation process of critically ill patients LI Zhen, LI Zunzhu, ZHOU Xiang, LI Qi, LUO Hongbo, SUN Jianhua, LIU Jinbang 2023, 4 (8):  711-715.  doi: 10.3761/j.issn.2096-7446.2023.08.007 Abstract ( 167 )   Save Peer support refers to the people with similar stress or health problems get gathered and obtain information and emotional support from each other. This article summarizes the implementation mode，intervention effects，mechanism and challenges of peer support in the rehabilitation process of ICU patients，and puts forward suggestions for further intervention and research in the future. Peer support can provide necessary support and help for severe patients，but the implementation mode and evaluation method need to be further optimized and improved. Related Articles | Metrics

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Research progress on activities of daily living of ICU patients ZHANG Xiying, JIANG Zhixia, ZHANG Fuyan, GAO Lin, YANG Xiaoling, ZHANG Sha, LIU Qilan 2023, 4 (8):  715-720.  doi: 10.3761/j.issn.2096-7446.2023.08.008 Abstract ( 349 )   Save Activities of daily living（ADL） is a basic ability for individuals to maintain daily life. Patients with severe diseases are usually dependent on ADL. In addition，due to the influence of post- intensive care syndrome，patients may experience long-term deterioration of ADL and continuous influence on the quality of life of patients after transferring out of ICU. This paper reviews the concept of ADL，the status of ADL of critically ill patients，influencing factors and improvement measures，and puts forward the shortcomings and suggestions in current research，aiming to provide reference for improving the ADL of critically ill patients and improving their long-term quality of life. Related Articles | Metrics

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Nursing care of neurofibromatosis type I involving the gastrointestinal tract combined with hemorrhage：a case report ZHU Huidi, JIANG Yuehong, LI Beibei, XU Qiaoying, WANG Mengxia, LI Dandan, FAN Limei, ZHAO Xuehong 2023, 4 (8):  721-724.  doi: 10.3761/j.issn.2096-7446.2023.08.009 Abstract ( 117 )   Save To summarize the nursing experience of a patient with type I neurofibromatosis involving the gastrointestinal tract combined with hemorrhage. In response to the preoperative hemostasis difficulties for multiple gastrointestinal mesenchymal tumor hemorrhage，high incidence of postoperative complications and systemic dermatofibroma，the following nursing measures were implemented：assessing the risk of rebleeding based on the Brachford scoring system to guide early warning care，paying attention to skin care to avoid breakage of the neurofibroma tumor，implementing postoperative risk management of duodenal fistula，implementing individualized psychological care combined with Chinese traditional medicine to promote postoperative gastroparesis，continuous nursing after discharge. The patient was successfully discharged from the hospital 32 days after surgery，and her weight was increased and recovered well during the follow-up of 3 months. Related Articles | Metrics

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Emergency nursing care of a patient with B-type aortic dissection whose first symptom was girdle sensation and paraplegia ZHAN Fenfang, WANG Sa, WANG Yuwei 2023, 4 (8):  725-727.  doi: 10.3761/j.issn.2096-7446.2023.08.010 Abstract ( 129 )   Save To summarize the emergency nursing experience of a patient with aortic dissection whose first symptom was girdle sensation with paraplegia of both lower limbs. Nursing points included using critical thinking to accurately triage and opening a green channel for critically ill patients，predictive nursing including indwelling high- pressure resistant venous catheter in advance and collecting blood samples，breaking the routine to control blood pressure individually，sufficient analgesia and psychological care. After accurate triage and effective treatment in the emergency department，the patient was safely transferred to the ward. One month later，he underwent endovascular isolation of thoracic aorta covered with stent and recovered. Related Articles | Metrics

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Nursing of a patient with stress cardiomyopathy treated by extracorporeal membrane oxygenation：a case report SONG Chenyang, ZHANG Xu, GU Ruirui, YE Jing 2023, 4 (8):  728-730.  doi: 10.3761/j.issn.2096-7446.2023.08.011 Abstract ( 125 )   Save This article summarized the nursing experience of a patient with stress cardiomyopathy treated by extracorporeal membrane oxygenation. For the patient with stress cardiomyopathy，it was necessary to avoid being in a state of stress and give the care to reduce stress response. At the same time，for patient with circulatory failure， we had done a good job in the nursing of extracorporeal membrane oxygenation. After 10 days of treatment and nursing，the patient recovered and discharged. Related Articles | Metrics

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Nursing care of a child with septic shock caused by Talaromyces marneffei infection in spinal cord YU Luyan, LIN Nan, FAN Jiajie 2023, 4 (8):  731-733.  doi: 10.3761/j.issn.2096-7446.2023.08.012 Abstract ( 103 )   Save To summarize the nursing care experience of a child with septic shock caused by Talaromyces marneffei （TM） infection. In view of the problems such as septic shock，refractory abdominal distension and difficulty in lower limb muscle strength recovery，active anti-shock and anti-infection treatment，gastrointestinal function protection and personalized rehabilitation training were taken. After 53 days of active treatment and careful care，the child was recovered and discharged. Related Articles | Metrics

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Nursing care of patients with severe fever and thrombocytopenia syndrome caused by novel Bunia virus YU Shanshan, ZHANG Xuhong, ZHAO Xuehong 2023, 4 (8):  734-737.  doi: 10.3761/j.issn.2096-7446.2023.08.013 Abstract ( 222 )   Save To summarize the nursing experience of 57 patients with severe fever and thrombocytopenia syndrome. In view of the transmission risk of novel Bunia virus，multiple organ function damage，and the uncertainty of patients and their families about the disease，strict disinfection and isolation measures were taken to prevent the spread of the disease；and we closely monitored the condition and test results to early and correctly identify early warning indicators for critically ill patients. We actively prevented complications and strengthened psychological nursing to give psychological support to patients and their families. After close monitoring and precise management， the patients were discharged from hospital from 1 to 30 days after admission，and the patients recovered well during the follow-up. Related Articles | Metrics

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Nursing of patients with descending necrotizing mediastinitis secondary to oral and maxillofacial space infection YE Guofeng, FU Mengqi 2023, 4 (8):  737-740.  doi: 10.3761/j.issn.2096-7446.2023.08.014 Abstract ( 111 )   Save The nursing experience of 10 cases of descending necrotizing mediastinitis secondary to oral and maxillofacial space infection was summarized. In terms of problems such as airway obstruction，mediastinal infection leading to dyspnea，postoperative placement of different drainage devices after interstitial infection，and postoperative serious complications in this group of patients，we adopted targeted airway management，postoperative pipeline management after thoracentesis treatment，personalized care of three different drainage devices and focused on patient complaints，implemented dynamic assessment of the risks of postoperative complications，timely judged and treated complications such as diabetic ketoacidosis，venous thromboembolism and gastrointestinal bleeding. After active treatment and nursing，the patients in this group improved significantly，and they were discharged from the hospital within 11 to 53 days. Related Articles | Metrics

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Analysis of the mediating effect of burnout between intention to leave and emotional labor among ICU nurse LI Wen, ZHANG Zhenyu, YU Yi, GAO Mingxiao, HE Yuxiao, JIANG Nannan, LI Chuansheng 2023, 4 (8):  741-746.  doi: 10.3761/j.issn.2096-7446.2023.08.015 Abstract ( 153 )   Save Objective To explore the mediating effect of burnout between emotional labor and intention to leave among ICU nurses. Methods A survey of 415 ICU nurses in six tertiary hospitals in Shandong Province was conducted using the General Information Questionnaire，the Nurses’ Emotional Labor Scale，the Nurses’ Burnout Scale，and the Intention to Leave Scale. Results The total emotional labor score of ICU nurses was （63.50±8.65）， which was at a medium level. The percentage of nurses with burnout was 90.29%. The mean score of intention to leave was （2.30±0.75），which was at a low level. Emotional labor and burnout both directly and positively predict intention to leave，and burnout partially mediated the relationship between emotional labor and intention to leave， with the mediating effect accounting for 31% of the total effect. Conclusion Managers need to adopt a variety of effective interventions to improve ICU nurses’ ability to perform emotional labor and alleviate burnout due to emotional labor，thereby reducing turnover intention. Related Articles | Metrics

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A systematic review of risk prediction models for post-stroke cognitive impairment WEI Hui, YANG Hongyan, YANG Ting, LIU Miaomiao, WU Minhao, GAO Yangqin 2023, 4 (8):  747-752.  doi: 10.3761/j.issn.2096-7446.2023.08.016 Abstract ( 216 )   Save Objective To systematically evaluate the risk prediction model of post-stroke cognitive impairment （PSCI），so as to provide reference for clinical doctors and nurses to select appropriate risk prediction model. Methods We searched PubMed，Embase，Web of Science Cochrane Library，CBM，CNKI，WanFang，and VIP for literature related to risk prediction model of PSCI from the inception of database to August 27，2022. Two researchers independently screened the literature and extracted data，PROBAST was used to assess the bias risk and applicability of the included literature，and RevMan 5.3 software was used to conduct meta-analysis on the common predictors in the included models. Results A total of 8 articles were included. The overall risk of bias of the literature was high，and its applicability was good. The area under the working characteristic curve of subjects in the 8 models was 0.807~0.930. Meta analysis showed that age[OR=1.05，95%CI（1.03，1.07）］，gender[OR=2.39， 95%CI （1.58，3.61）］，diabetes [OR =3.55，95%CI （1.67，7.55）］，and number of non-lacunar infarcts [OR =1.59，95% CI （1.21，2.09）］ were all effective predictors of PSCI. Conclusion The PSCI risk prediction model has good prediction efficiency and high overall bias risk. When reporting the risk prediction model，future researchers should refer to PROBAST’s reporting specifications，and clinical medical staff should timely assess the risk of PSCI in elderly stroke patients，women，patients with diabetes and non-lacunar infarction. Related Articles | Metrics

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Best evidence summary for emergency treatment of adult patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation DENG Yuyang, ZENG Ying, TIAN Dan, HUANG Qing, ZHOU Wei, ZHOU Li, SHI Xiaochen, WU Sha, HAO Jie 2023, 4 (8):  753-759.  doi: 10.3761/j.issn.2096-7446.2023.08.017 Abstract ( 238 )   Save Objective To retrieve，evaluate and summarize the best evidence for emergency treatment of adult patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation，so as to provide reference for clinical practice. Methods According to the “6S” evidence model，we searched all relevant databases and website， such as UpToDate，BMJ Best Practice，National Guideline Clearinghouse，American Heart Association，SinoMed， CNKI，Wanfang Database，Embase，PubMed，Cochrane Library，CINAHL，Joanna Briggs Institute （JBI） Evidence Based Healthcare Database，from the establishment of the database to July 10，2022. The quality of included literature was evaluated. Results A total of 12 articles were included，including 1 clinical decision，6 guidelines and 5 expert consensuses. 22 pieces of best evidence were summarized from 6 aspects，including assessment，initiation and implementation，monitoring and management，primary disease treatment，evacuation and management principles. Conclusion The best evidence for the emergency treatment of adult cardiac arrest patients with extracorporeal cardiopulmonary resuscitation is scientific and clinically applicable，which could provide guidance for emergency medical staff. Clinical application should be based on hospital characteristics and patients’ specific conditions，so as to improve the quality of emergency extracorporeal cardiopulmonary resuscitation. Related Articles | Metrics

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Research progress of medication self-management in patients with hematopoietic stem cell transplantation PAN Zhengwen, ZHOU Xiaoyu, ZHOU Weiwei, XU Liwei, ZHANG Jianli, YAN Yuexia 2023, 4 (8):  760-764.  doi: 10.3761/j.issn.2096-7446.2023.08.018 Abstract ( 152 )   Save Medication self-management emphasizes patient preparation and use of medication，and maintains safe use of drugs for a period of time to successfully manage their own treatment plan，which can affect the short-term and long-term prognosis of patients undergoing hematopoietic stem cell transplantation （HSCT）. Accurate assessment of patient medication compliance can help medical staff understand the appropriateness，effectiveness and safety of patient medication，adjust the treatment plan in time，and also provide a basis for the formulation of medication self- management plan for patients with HSCT. This article reviews the influencing factors，evaluation and intervention strategies of medication self-management in patients with HSCT，in order to provide a reference for related research. Related Articles | Metrics

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Design and application of multi-functional detachable special transport bracket for extracorporeal membrane oxygenation YANG Xiangying, PENG Qiaoqiao, HUANG Pei 2023, 4 (8):  765-768.  doi: 10.3761/j.issn.2096-7446.2023.08.019 Abstract ( 113 )   Save Objective To design a multifunctional detachable special transport bracket for extracorporeal membrane oxygenation and explore its application effect in patient transport. Methods The multi-functional detachable extracorporeal membrane oxygenation special bracket was composed of infusion rod，extension part， drawer，support leg，hand pump，upper placement plate，oxygen barrel，lower placement plate，caster，bottom plate， support plate，etc. A total of 72 patients treated with extracorporeal membrane oxygenation in the ICU of a hospital in Hangzhou were selected as the study subjects. The control group was transported by the synchronous transfer method of transfer bed and extracorporeal membrane oxygenation component，and the experimental group was transported by the multifunctional detachable extracorporeal membrane oxygenation special transport bracket. The differences in transport time，number of people required for transport，and incidence of adverse events during transport were compared between the two groups. Results The transport time of the experimental group was （21.37±6.93） s，which was shorter than that of the control group （33.24±7.84） s，and the difference was statistically significant （t=11.127，P<0.001）. The number of people required for transport in the experimental group （3.13±0.71） was lower than that of the control group（5.21±1.92），and the difference was statistically significant（t=-9.876，P<0.001）. There was no difference between patient-related and personnel-related adverse events in the experimental group （χ2=0.613，0.001，P>0.05），while the incidence of instrument-related adverse events was significantly lower than that in the control group（χ2=8.218，P<0.05）. Conclusion The application of multi-functional detachable special transport bracket for extracorporeal membrane oxygenation in patients can effectively improve work efficiency，reduce the incidence of adverse events. Related Articles | Metrics