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Low volume ECMO results study
Christopher J Joyce, David A Cook, James Walsham, Anand Krishnan, Wingchi Lo, John Samaan, Andrew J Semark, David C Pearson, Andrie Stroebel, Sylvio Provenzano, Ronan McKeague, James R Winearls
Crit Care Resusc 2020; 22 (4): 327-334
- Christopher J Joyce 1, 2
- David A Cook 1, 2, 3
- James Walsham 1, 2
- Anand Krishnan 1, 2
- Wingchi Lo 2, 4
- John Samaan 2, 5
- Andrew J Semark 2, 6
- David C Pearson 6
- Andrie Stroebel 7
- Sylvio Provenzano 7
- Ronan McKeague 6
- James R Winearls 2, 6, 8, 9
OBJECTIVES: To report extracorporeal membrane oxygenation (ECMO) experience at Princess Alexandra and Gold Coast University hospitals and compare mortality with benchmarks.
DESIGN: Case series of patients treated with ECMO.
SETTING: Two adult tertiary Australian intensive care units with low ECMO case volumes.
PARTICIPANTS: Patients treated with ECMO, aged > 18 years.
MAIN OUTCOME MEASURES: Patients were categorised into respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation (eCPR) groups. Observed mortality was compared with mortality predicted using individual risk of death predictions from the Survival after Veno-arterial ECMO (SAVE) and Respiratory ECMO Survival Prediction (RESP) scores; mortality predicted when mortality predictions of the SAVE score were modified to be consistent with the validation cohort in the SAVE study (Alfred Hospital); and with mortality predicted when eCPR patients were all assigned a risk of death equal to Extracorporeal Life Support Organization (ELSO) Registry eCPR mortality. RESULTS: Over 10 years, 86 patients were treated with ECMO. Eight deaths were observed in 49 patients with respiratory failure, below the 95% CI (13–24) for the deaths predicted by the RESP score (P < 0.001). Nine deaths were observed in 27 patients with cardiac failure, below the 95% CI (14– 23) for the deaths predicted by the SAVE score (P < 0.001), but within the 95% CI (9–17) for the deaths predicted by the SAVE score modified to be consistent with the Alfred Hospital cohort (P > 0.05). Seven deaths were observed in the ten eCPR patients, within the 95% CI (4–10) predicted using the risk of death derived from the ELSO Registry.
CONCLUSIONS: Mortality in two low volume ECMO centres was not inferior to benchmarks.
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Respiratory ECMO was provided to 49 patients and eight died (mortality rate, 16%). Cardiac ECMO was provided to 27 patients and nine died (mortality rate, 33%). eCPR was provided to ten patients and seven died (mortality rate, 70%). All patients who survived their continuous episode of ICU care were discharged home alive. Some had prolonged admission to rehabilitation facilities, mainly due to injuries from trauma.