Two Decades’ Experience With Interfacility Transport on Extracorporeal Membrane Oxygenation

Bryner, Benjamin S.; Cooley, Elaine; Copenhaver, William; Brierley, Kristin; Teman, Nicholas R.; Landis, Denise; Rycus, Peter; Hemmila, Mark R.; Napolitano, Lena M.; Haft, Jonathan W.; Park, Pauline K.; Bartlett, Robert H.

doi:10.1016/j.athoracsur.2014.06.025

Cited by 134 publications

(134 citation statements)

References 31 publications

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“…Hospital ECMO volume may increase through selective referral to hospitals reputed to have favorable ECMO outcomes (1,39). In "practice makes perfect," increased experience improves performance and thereby outcomes.…”

Section: Implications: Volume-outcome Considerations For Ecmomentioning

confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

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Rationale: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers.Objectives: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. Methods:We retrospectively analyzed an international registry of ECMO support from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to ,18 yr), and adult (>18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospitallevel variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013.Measurements and Main Results: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases.Conclusions: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013.

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Section: Implications: Volume-outcome Considerations For Ecmomentioning

confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

Self Cite

592

400

View full text Add to dashboard Cite

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“…Interfacility transport of ECMO-supported patients has been described in several published series over the last couple decades (10,12,13). In general ECMO transport is associated with low rates of complications and very low rates of significant complications.…”

Section: Discussionmentioning

confidence: 99%

“…Many ECMO transport teams send personnel to cannulate patients at the referring hospital prior to transport back, meaning the patient's ECMO course begins almost immediately preceding departure (10,12,13,18,19). Such teams provide ECMO services to critically ill patients too ill to be transported conventionally to an ECMO center.…”

Section: Discussionmentioning

confidence: 99%

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

2017

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Pediatric lung transplantation is a life-saving intervention for children with irreversible endstage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant.

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“…Th e thought of providing temporary extracorporeal support to allow stabilization of other end organs and allow defi nitive treatment of the primary organ has been available at a few specialized centers for decades. [9][10][11][12] However, with the development of many new technologies, the use of extracorporeal support has continued to increase. 2 What was once believed to be a rare salvage therapy is now rapidly becoming a commonly considered, potentially eff ective option in high-mortality situations.…”

mentioning

confidence: 99%

Clinical and Billing Review of Extracorporeal Membrane Oxygenation

Blum

Lynch

Coopersmith

2015

Chest

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Two Decades’ Experience With Interfacility Transport on Extracorporeal Membrane Oxygenation

Cited by 134 publications

References 31 publications

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

Clinical and Billing Review of Extracorporeal Membrane Oxygenation

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