Chow Joanna Wy, Dyett John F, Hirth Steve, Hart Julia, Duke Graeme J
Box Hill Hospital, Eastern Health, VIC, Australia.
Alfred Hospital, Alfred Health, VIC, Australia.
Crit Care Resusc. 2023 Dec 13;26(1):47-53. doi: 10.1016/j.ccrj.2023.11.007. eCollection 2024 Mar.
Victoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described.
Describe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access.
Retrospective observational study with spatial mapping.
Adult (≥18 years) ECMO recipients from July 2016-June 2022. Data from administrative Victorian Admissions Episodes Database analysed in conjunction with Australian Urban Research Infrastructure Network population data and choropleth mapping. Presumed ECMO modes were inferred from cardiopulmonary bypass and pre-hospital cardiac arrest codes. Spatial autoregressive models including Moran's test used for spatial lag testing.
Demographics and outcomes of ECMO recipients; ECMO incidence by patient residence (Statistical-Area Level 2, SA-2) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD); and ECMO utilisation adjusted for patient factors and linear distance from the central ECMO referral site.
631 adults received ECMO over 6 years, after exclusion of paediatric (n = 242), duplicate (n = 135), and interstate or incomplete (n = 72) records. Mean age was 51.8 years, and 68.8 % were male. Overall ECMO incidence was 3.00 ± 3.95 per 10 population. 135 (21.4 %) were presumed VA-ECMO, 59 (9.3 %) presumed ECPR, and 437 (69.3 %) presumed VV-ECMO. Spatial lag was non-significant after adjusting for patient characteristics. Distance from the central referral site (dy/dx = 0.19, 95% CI -0.41-0.04, p = 0.105) and IRSAD score (dy/dx = 0.17, 95% CI -0.19-0.53, p = 0.359) did not predict ECMO utilisation.
Victorian ECMO incidence rates were low. We did not find evidence of inequity of access to ECMO irrespective of regional area or socioeconomic status.
澳大利亚维多利亚州提供由救护车转运支持的集中式州级体外膜肺氧合（ECMO）服务。此前尚未描述过该服务的公平可及性。
描述接受ECMO治疗者的特征，并量化地理和社会经济因素对可及性的影响。
采用空间映射的回顾性观察研究。
2016年7月至2022年6月期间接受ECMO治疗的成年（≥18岁）患者。对维多利亚州行政入院病历数据库中的数据，结合澳大利亚城市研究基础设施网络人口数据和分级统计图进行分析。根据体外循环和院前心脏骤停代码推断假定的ECMO模式。使用包括莫兰检验在内的空间自回归模型进行空间滞后检验。
ECMO接受者的人口统计学特征和治疗结果；按患者居住地（统计区2级，SA - 2）和相对社会经济优势与劣势指数（IRSAD）划分的ECMO发病率；以及根据患者因素和距中央ECMO转诊地点的直线距离调整后的ECMO利用率。
排除儿科（n = 242）、重复（n = 135）以及州际或不完整（n = 72）记录后，631名成年人在6年期间接受了ECMO治疗。平均年龄为51.8岁，68.8%为男性。总体ECMO发病率为每10万人3.00±3.95例。135例（21.4%）推测为静脉 - 动脉ECMO，59例（9.3%）推测为体外心肺复苏（ECPR），437例（69.3%）推测为静脉 - 静脉ECMO。在调整患者特征后，空间滞后无统计学意义。距中央转诊地点的距离（dy/dx = 0.19，95%置信区间 - 0.41 - 0.04，p = 0.105）和IRSAD评分（dy/dx = 0.17，95%置信区间 - 0.19 - 0.53，p = 0.359）均不能预测ECMO的利用率。
维多利亚州的ECMO发病率较低。无论地区或社会经济地位如何，我们均未发现ECMO可及性存在不公平的证据。
