Ertugrul Atacan D, Neto Ary Serpa, Fulcher Bentley J, Charles-Nelson Anaïs, Bailey Michael, Burrell Aidan J C, Anderson Shannah, Bernard Stephen, Board Jasmin V, Brodie Daniel, Buhr Heidi, Cooper D James, Dicker Craig, Fan Eddy, Fraser John F, Gattas David J, Hopper Ingrid K, Huckson Sue, Linke Natalie J, Litton Edward, McGuinness Shay P, Nair Priya, Orford Neil, Parke Rachael L, Pellegrino Vincent A, Pilcher David V, Stub Dion, Udy Andrew A, Reddi Benjamin A J, Trapani Tony V, Jones Annalie, Higgins Alisa M, Hodgson Carol L
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Australia.
Crit Care Resusc. 2024 Nov 22;26(4):262-270. doi: 10.1016/j.ccrj.2024.08.006. eCollection 2024 Dec.
Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.
This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).
Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65-1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66-1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37-5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.
There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
体外膜肺氧合（ECMO）是一项高风险操作，具有较高的发病率和死亡率，且存在不确定的容量-结局关系，尤其是在长期功能结局方面。本研究的目的是探讨ECMO中心容量与长期死亡和残疾结局之间的关联。
设计、设置和参与者：这是一项基于注册登记的观察性队列研究。纳入参加双边ECMO注册登记（EXCEL）的患者。排除标准包括因心脏/肺移植而接受ECMO治疗的患者。数据包括人口统计学信息、首次ECMO治疗的临床信息以及通过电话访谈获得的六个月结局。主要结局是六个月时的死亡或新发残疾。使用医院的年度ECMO容量进行多变量分析。高容量中心定义为每年有>30例ECMO病例，并对静脉-静脉（VV）、静脉-动脉（VA）和体外心肺复苏（ECPR）的ECMO亚组进行分析。
在1232例患者中，663例在高容量中心接受ECMO治疗，569例在低容量中心接受治疗。在VV-ECMO [比值比（OR）：1.09（0.65-1.83），p = 0.744]、VA-ECMO [OR：1.10（0.66-1.84），p = 0.708]和ECPR-ECMO [OR：1.38（0.37-5.08），p = 0.629]中，高容量和低容量ECMO中心在六个月时的死亡或新发残疾方面没有差异。这一发现在所有敏感性分析中均持续存在，包括排除在高容量和低容量中心之间转诊的患者。
在澳大利亚和新西兰，高容量和低容量中心在六个月时的死亡或残疾方面没有差异，这可能归因于当前的协调护理模式，包括我们地区高容量和低容量ECMO中心之间的患者转诊和培训。
