Ng Pauline Yeung, Ip April, Fang Shu, Lin Jeremy Chang Rang, Ling Lowell, Chan Kai Man, Leung Kit Hung Anne, Chan King Chung Kenny, So Dominic, Shum Hoi Ping, Ngai Chun Wai, Chan Wai Ming, Sin Wai Ching
Department of Medicine, The University of Hong Kong, Hong Kong, China.
Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.
J Thorac Dis. 2022 Jun;14(6):1802-1814. doi: 10.21037/jtd-21-1512.
The utilization of extracorporeal membrane oxygenation (ECMO) has increased rapidly around the world. Being an overall low-volume high-cost form of therapy, the effectiveness of having care delivered in segregated units across a geographical locality is debatable.
All adult extracorporeal membrane oxygenation cases admitted to public hospitals in Hong Kong between 2010 and 2019 were included. "High-volume" centers were defined as those with >20 extracorporeal membrane oxygenation cases in the respective calendar year, while "low-volume" centers were those with ≤20. Clinical outcomes of patients who received extracorporeal membrane oxygenation care in high-volume centers were compared with those in low-volume centers.
A total of 911 patients received extracorporeal membrane oxygenation-297 (32.6%) veno-arterial extracorporeal membrane oxygenation, 450 (49.4%) veno-venous extracorporeal membrane oxygenation, and 164 (18.0%) extracorporeal membrane oxygenation-cardiopulmonary resuscitation. The overall hospital mortality was 456 (50.1%). The annual number of extracorporeal membrane oxygenation cases in high- and low-volume centers were 29 and 11, respectively. Management in a high-volume center was not significantly associated with hospital mortality (adjusted odds ratio (OR) 0.86, 95% confidence interval (CI): 0.61-1.21, P=0.38), or with intensive care unit mortality (adjusted OR 0.76, 95% CI: 0.54-1.06, P=0.10) compared with a low-volume center. Over the 10-year period, the overall observed mortality was similar to the Acute Physiology And Chronic Health Evaluation IV-predicted mortality, with no significant difference in the standardized mortality ratios between high- and low-volume centers (P=0.46).
In a territory-wide observational study, we observed that case volumes in extracorporeal membrane oxygenation centers were not associated with hospital mortality. Maintaining standards of care in low-volume centers is important and improves preparedness for surges in demand.
体外膜肺氧合（ECMO）在全球范围内的应用迅速增加。作为一种总体上低容量、高成本的治疗方式，在不同地理位置的隔离单元提供护理的有效性存在争议。
纳入2010年至2019年间入住香港公立医院的所有成人体外膜肺氧合病例。“高容量”中心定义为在各日历年有超过20例体外膜肺氧合病例的中心，而“低容量”中心则为有20例及以下病例的中心。比较在高容量中心接受体外膜肺氧合护理的患者与在低容量中心接受护理的患者的临床结局。
共有911例患者接受了体外膜肺氧合治疗，其中297例（32.6%）为静脉-动脉体外膜肺氧合，450例（49.4%）为静脉-静脉体外膜肺氧合，164例（18.0%）为体外膜肺氧合-心肺复苏。总体医院死亡率为456例（50.1%）。高容量中心和低容量中心每年的体外膜肺氧合病例数分别为29例和11例。与低容量中心相比，在高容量中心接受治疗与医院死亡率（调整后的优势比（OR）为0.86，95%置信区间（CI）：0.61 - 1.21，P = 0.38）或重症监护病房死亡率（调整后的OR为0.76，95%CI：0.54 - 1.06，P = 0.10）无显著相关性。在这10年期间，总体观察到的死亡率与急性生理与慢性健康状况评价IV预测的死亡率相似，高容量中心和低容量中心之间的标准化死亡率比值无显著差异（P = 0.46）。
在一项全地区的观察性研究中，我们观察到体外膜肺氧合中心的病例数量与医院死亡率无关。维持低容量中心的护理标准很重要，并且能提高应对需求激增的准备能力。
