Venovenous extracorporeal membrane oxygenation treatment in a low‐volume and geographically isolated cardiothoracic centre

Ingvarsdóttir, Inga Lára; Viðarsdóttir, Halla; Valsson, Felix; Símonardóttir, Líney; Sigurdsson, Martin I.; Myrdal, Gunnar; Geirsson, Arnar; Guðbjartsson, Tómas

doi:10.1111/aas.13367

Cited by 3 publications

(10 citation statements)

References 25 publications

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“…6,14,15 In fact, even very low-volume hospitals have revealed short-and long-term outcomes in patients undergoing V-V ECMO comparable to larger centers. 27 So why have we not been able to identify any volumeoutcome relationship? First of all, only two of the mentioned studies analyzing ECLS volume and outcome investigated specifically patients undergoing V-V ECMO.…”

Section: Discussionmentioning

confidence: 99%

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Annual hospital procedural volume and outcome in extracorporeal membrane oxygenation for respiratory failure

et al. 2022

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Background The hospital mortality of patients suffering from pulmonary failure requiring venovenous extracorporeal membrane oxygenation (V‐V ECMO) or extracorporeal carbon dioxide removal (ECCO2R) is high. It is unclear whether outcome correlates with a hospital's annual procedural volume. Methods Data on all V‐V ECMO and ECCO2R cases treated from 2007 to 2019 were retrieved from the German Institute for Medical Documentation and Information. Comorbidities and outcomes were assessed by DRG, OPS, and ICD codes. The study population was divided into 5 groups depending on annual hospital V‐V ECMO and ECCO2R volumes (<10 cases; 10–19 cases; 20–29 cases; 30–49 cases; ≥50 cases). Primary outcome was hospital mortality. Results A total of 25 096 V‐V ECMO and 3607 ECCO2R cases were analyzed. V‐V ECMO hospitals increased from 89 in 2007 to 214 in 2019. Hospitals handling <10 cases annually increased especially (64 in 2007 to 149 in 2019). V‐V ECMO cases rose from 807 in 2007 to 2597 in 2019. Over 50% of cases were treated in hospitals handling ≥30 cases annually. Hospital mortality was independent of the annual hospital procedural volume (55.3%; 61.3%; 59.8%; 60.2%; 56.3%, respectively, p = 0.287). We detected no differences when comparing hospitals handling <30 cases to those with ≥30 annually (p = 0.659). The numbers of ECCO2R hospitals and cases has dropped since 2011 (287 in 2007 to 48 in 2019). No correlation between annual hospital procedural volume and hospital mortality was identified (p = 0.914). Conclusion The number of hospitals treating patients requiring V‐V ECMO and V‐V ECMO cases rose from 2007 to 2019, while ECCO2R hospitals and their case numbers decreased. We detected no correlation between annual hospital V‐V ECMO or ECCO2R volume and hospital mortality.

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Section: Discussionmentioning

confidence: 99%

“…Although it is suggested that hospitals with more experience are rewarded with better results, this has not been demonstrated consistently in the ECLS literature 6,14,15 . In fact, even very low‐volume hospitals have revealed short‐ and long‐term outcomes in patients undergoing V‐V ECMO comparable to larger centers 27 …”

Section: Discussionmentioning

confidence: 99%

Annual hospital procedural volume and outcome in extracorporeal membrane oxygenation for respiratory failure

et al. 2022

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“…44,46,48,49,51 However, volume per se might not be the leading factor; several important factors include training, protocols, team expertise, benchmarking, maintaining a low threshold for asking for support. 51,53,68…”

Section: Discussionmentioning

confidence: 99%

“…It has also been suggested that the lower mortality reported by low-volume centers supports the importance of timely access to local ECLS. 43,[50][51][52][53][54][55][56] Furthermore, volume per se might not be the leading factor; several important factors include training, protocols, team expertise, benchmarking, and maintaining a low threshold for asking for support. 51,53 Other nations included in GENERATE present a different picture.…”

Section: Discussionmentioning

confidence: 99%

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

et al. 2023

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Introduction A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. Methods Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. Results 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2 hours in 21 of 37 countries (56.8%) and within 3 hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0–14 within 1 hour and 23 of 37 countries (62.2%) within 2 hours and 3 hours. Conclusions ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.

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“…Nonetheless, it ties in with the concept of human factors, that more ECLS training may be needed low volume center to have better the clinical outcomes. 49 , 50 , 51 , 52 , 53 …”

Section: Ecls As a Team Approachmentioning

confidence: 99%

Human factors in ECLS – A keystone for safety and quality – A narrative review for ECLS providers

et al. 2021

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Introduction Although the technology used for extracorporeal life support (ECLS) has improved greatly in recent years, the application of these devices to the patient is quite complex and requires extensive training of team members both individually and together. Human factors is an area that addresses the activities, contexts, environments, and tools which interact with human behavior in determining overall system performance. Hypothesis Analyses of the cognitive behavior of ECLS teams and individual members of these teams with respect to the occurrence of human errors may identify additional opportunities to enhance safety in delivery of ECLS. Results The aim of this article is to support health‐care practitioners who perform ECLS, or who are starting an ECLS program, by establishing standards for the safe and efficient use of ECLS with a focus on human factor issues. Other key concepts include the importance of ECLS team leadership and management, as well as controlling the environment and the system to optimize patient care. Conclusion Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.

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Venovenous extracorporeal membrane oxygenation treatment in a low‐volume and geographically isolated cardiothoracic centre

Cited by 3 publications

References 25 publications

Annual hospital procedural volume and outcome in extracorporeal membrane oxygenation for respiratory failure

Annual hospital procedural volume and outcome in extracorporeal membrane oxygenation for respiratory failure

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

Human factors in ECLS – A keystone for safety and quality – A narrative review for ECLS providers

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