We aimed to analyse the outcomes of the deployment of extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) 11 times for acute myocardial infarction (AMI) in 10 adult patients at a very low-volume (VLV) centre, where perfusionists or surgeons are not always available. We conducted a three-year retrospective chart review. E-CPR was performed 13 times in 12 adult patients who had cardiac arrest events and who underwent conventional CPR for longer than 10 min. We excluded other aetiologies that led to E-CPR. All 11 selected episodes of E-CPR were diagnosed as AMI. Seven patients (63.6%) were successfully weaned off extracorporeal membrane oxygenation (ECMO). Four patients survived to discharge without neurological deficits or other postE-CPR complications (36.3%). Seven patients died after E-CPR, and with one patient, there was no return of spontaneous beating during E-CPR (0.9%). Three patients died of unstable haemodynamics despite revascularisation of the coronary circulation. Three patients were successfully weaned off ECMO; however, they died subsequently of multiple organ dysfunction, unstable haemodynamic changes and septic shock from nosocomial infections, respectively. The outcome of E-CPR in adults with AMI was compared with previous studies at high-volume centres. Mortality or morbidity rates are not higher at a VLV centre.

The purpose of this research is to discover valuable medical facts by mining TKA (total knee arthroplasty) surgical volume of three different hospital levels from Taiwan NHI (National Health Insurance) database. In this paper, there are three main objectives provided: (1) to build up the learning curves using the patients' outcomes of three different hospital levels; (2) to characterize whether TKA surgical volume correlates with infection rate and mortality rate; and (3) to examine whether there are differences in the infection rate and mortality rate pair-wise comparisons among medical center, district hospital, and local hospital.After building up the learning curves, the results of Ztest confirm the differences between these three observed levels. For verification, we've interviewed five specialist surgeons with a semi-structure questionnaire containing some close questions and some open-end, and the investigative results are consistent with the results from data analysis.