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Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital

McCaffrey, Joe, Orford, Neil R., Simpson, Nicholas, Jenkins, Jill Lamb, Morley, Christopher and Pellegrino, Vin 2016, Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital, Critical care and resuscitation journal, vol. 18, no. 4, pp. 235-241.

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Title Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital
Author(s) McCaffrey, Joe
Orford, Neil R.ORCID iD for Orford, Neil R. orcid.org/0000-0002-2285-9233
Simpson, Nicholas
Jenkins, Jill Lamb
Morley, Christopher
Pellegrino, Vin
Journal name Critical care and resuscitation journal
Volume number 18
Issue number 4
Start page 235
End page 241
Total pages 7
Publisher College of Intensive Care Medicine of Australia and New Zealand
Place of publication Prahran, Vic.
Publication date 2016-12
ISSN 1441-2772
Keyword(s) Adult
Aged
Australia
Cohort Studies
Extracorporeal Membrane Oxygenation
Female
Hospitals, University
Humans
Intensive Care Units
Male
Middle Aged
Models, Organizational
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
ADULT PATIENTS
MORTALITY
VOLUME
ORGANIZATION
ASSOCIATION
PROGRAMS
SURVIVAL
FAILURE
CARE
Summary BACKGROUND: The role of extracorporeal membrane oxygenation (ECMO) for adults in regional centres with low numbers of patients receiving ECMO is unclear. A robust service delivery model may assist in the quality provision of ECMO.

OBJECTIVE: To describe a novel ECMO service delivery model in a regional Australian hospital, reporting on patient characteristics and outcomes before and after its implementation.

METHODS: An observational cohort study of all patients receiving ECMO at the University Hospital Geelong intensive care unit before and after implementation of a new ECMO clinical service model. The program included intensivist training in cannulation and care for ECMO patients, nurse accreditation in ECMO maintenance, and establishing a relationship with an ECMO centre caring for a high number of patients. Data included ECMO caseload, circuit configuration, complications, durations of therapy, and survival to ECMO weaning and ICU and hospital discharge.

RESULTS: During the 14-year period for which we collected data, 61 adults received ECMO: 21 (35%) before and 40 (65%) after implementation of the structured program. The median annual case rate increased significantly between periods from two (range, 0-5 cases) to 10 (range, 5-13 cases) (P < 0.01). Other changes from before to after implementation included more medical indications for ECMO (48% v 80%; P < 0.01), higher peripheral cannulation configuration (57% v 98%; P < 0.01) and greater intensivist involvement as cannulation proceduralists (29% v 80%; P < 0.01). There were no significant differences between cohorts in ECMO weaning or duration, complication rates or ICU or in-hospital mortality.

CONCLUSIONS: Provision of ECMO in a tertiary regional hospital within a multifaceted clinical service model is feasible and safe. Partnership with a centre providing ECMO for a high number of patients during service development and delivery is desirable.
Language eng
Field of Research 1103 Clinical Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2016, College of Intensive Care Medicine of Australia and New Zealand
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30112692

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.