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

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Version 1 2018-08-24, 14:06
journal contribution
posted on 2024-06-03, 18:06 authored by J McCaffrey, Neil OrfordNeil Orford, Nick SimpsonNick Simpson, JL Jenkins, C Morle, V Pellegrino
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.

History

Journal

Critical Care and Resuscitation

Volume

18

Pagination

235-241

Location

Australia

Open access

  • Yes

ISSN

1441-2772

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2016, College of Intensive Care Medicine of Australia and New Zealand

Issue

4

Publisher

AUSTRALASIAN MED PUBL CO LTD