Low volume ECMO results study

Abstract

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.

In this issue of CCR

“…These questions are addressed by two important observational studies in Australia. 9 , 10 The results support the widespread quality of intensive care management in our region.…”

Lower limb ischaemia in patients on extracorporeal membrane oxygenation: an approach to diagnosis

“…It is recognized that a temporary diverting ileostomy (TDI) does not prevent anastomotic leak (AL) but does mitigate the magnitude of the clinical consequences. [1][2][3] There is geographical variation in the strategy regarding TDI usage in Australia and New Zealand, with a statistically significant difference in the use of mandatory TDIs in ileal pouch surgery (P = 0.029). 4 Australasian surgeons employ a TDI in 89% of rectal cancer resections, whilst reporting an AL rate of 5.2%.…”

“…Mortality rates are high for these patients, with serious morbidity, renal failure and lower limb ischaemia (LLI) common. The Alfred Hospital in Melbourne has the highest ECMO caseload in Australia 3 . As such, this heterogenous and complex group of patients form an important proportion of acute referrals to our vascular surgery department.…”

“…The Alfred Hospital in Melbourne has the highest ECMO caseload in Australia. 3 As such, this heterogenous and complex group of patients form an important proportion of acute referrals to our vascular surgery department. Despite increasing worldwide experience in managing patients on ECMO, the appropriate algorithm for diagnosis and investigation of LLI for patients on ECMO is still poorly defined.…”