Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital
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 regio...
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Veröffentlicht in: | Critical care and resuscitation 2016-12, Vol.18 (4), p.235-241 |
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Sprache: | eng |
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Zusammenfassung: | 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 confi guration, 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 signifi cantly 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 confi guration (57% v 98%; P < 0.01) and greater intensivist involvement as cannulation proceduralists (29% v 80%; P < 0.01). There were no signifi cant 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. |
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ISSN: | 1441-2772 |
DOI: | 10.1016/S1441-2772(23)00798-6 |