SESSION TITLE: ECMO Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of critically ill patients has greatly increased. The number of ECMO centers worldwide has more than doubled in the last decade as reported by the Extracorporeal Life Support Organization. Prior studies have suggested ECMO outcomes in adult patients are directly related to annual center volume. We analyzed our ECMO experience during the transition from a low to a high volume center.
METHODS: We retrospectively reviewed all adult ECMO cases at our institution from 2011- 2014. The low volume era (2011-2012) was defined as period 1 (P1) and the high volume era (2013-2014) as period 2 (P2). Logistic regression was used to determine factors associated with survival to hospital discharge.
RESULTS: A total of 144 patients were supported with ECMO: 13 in 2011and 13 in 2012 (P1), compared to 52 in 2013 and 66 in 2014 (P2). P1 and P2 cohorts were similar in mean age, gender and racial composition. SOFA score at ECMO initiation was 9.85±5.3 (P1) and 12.43±4.02 (P2), p=0.006. Respiratory failure as the indication for ECMO increased from 42.3% in P1 to 64.4% in P2, p=0.046. Transfers from outside facilities increased from 0% to 20.34%, p=0.044. Mean ECMO duration increased from 5.2 ± 6.4 days (P1) to 9.4 ± 9 days (P2), p=0.009. However, duration of mechanical ventilation, and ICU and hospital length of stay were not statistically different. ECMO survival improved from 38.5% (P1) to 68.7% (P2), p=0.004. Survival to hospital discharge improved from 30.8% (P1) to 56.8% (P2), p=0.02. Multivariable logistic regression identified low annual volume (OR 4.1, p=0.02), older age (OR 1.03, p=0.02) and hospital length of stay (OR 0.97, p<0.0001) as being associated with reduced survival to hospital discharge.
CONCLUSIONS: Higher annual ECMO volume was associated with improved survival to hospital discharge.
CLINICAL IMPLICATIONS: Higher center volume improves the quality of ECMO care. The relationship between increased volume and improvement in specific practices, protocols and multidisciplinary management warrants further investigation.
DISCLOSURE: The following authors have nothing to disclose: Krittika Teerapuncharoen, Aida Venado, Pilar Acosta Lara, Enrique Diaz-Guzman, Keith Wille
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