Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

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dc.contributor.authorErtugrul, A.D.
dc.contributor.authorNeto, A.S.
dc.contributor.authorFulcher, B.J.
dc.contributor.authorCharles-Nelson, A.
dc.contributor.authorBailey, M.
dc.contributor.authorBurrell, A.J.C.
dc.contributor.authorAnderson, S.
dc.contributor.authorBernard, S.
dc.contributor.authorBoard, J.V.
dc.contributor.authorBrodie, D.
dc.contributor.authorBuhr, H.
dc.contributor.authorCooper, D.J.
dc.contributor.authorDicker, C.
dc.contributor.authorFan, E.
dc.contributor.authorFraser, J.F.
dc.contributor.authorGattas, D.J.
dc.contributor.authorHopper, I.K.
dc.contributor.authorHuckson, S.
dc.contributor.authorLinke, N.J.
dc.contributor.authorLitton, E.
dc.contributor.authoret al.
dc.date.issued2024
dc.description.abstractObjective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes. Design, setting, and participants: This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR). Results: Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65e1.83), p ¼ 0.744], VA-ECMO [OR: 1.10 (0.66 e1.84), p ¼ 0.708], and ECPR-ECMO [OR: 1.38 (0.37e5.08), p ¼ 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and lowvolume centres. Conclusion: There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
dc.description.statementofresponsibilityAtacan D. Ertugrul ... Benjamin A.J. Reddi ... et al., on behalf of the EXCEL Study Investigators and the International ECMO Network (ECMONet)
dc.identifier.citationCritical Care and Resuscitation, 2024; 26(4):262-270
dc.identifier.doi10.1016/j.ccrj.2024.08.006
dc.identifier.issn1441-2772
dc.identifier.issn2652-9335
dc.identifier.urihttps://hdl.handle.net/2440/147949
dc.language.isoen
dc.publisherElsevier BV
dc.relation.grantNHMRC
dc.rights© 2024 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
dc.source.urihttp://dx.doi.org/10.1016/j.ccrj.2024.08.006
dc.subjectAnaesthesia and intensive care; Emergency medicine; Extracorporeal life support; Intensive care; Cardiac perfusion; Cardiac failure; Resuscitation; Acute respiratory distress syndrome (ARDS)
dc.titleHospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months
dc.typeJournal article
pubs.publication-statusPublished

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