Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

Atacan D. Ertugrul; Ary Serpa Neto; Bentley Fulcher; Anaïs Charles-Nelson; Michael Bailey; Aidan Burrell; Shannah Anderson; Stephen Bernard; Jasmin Board; Daniel Brodie; Heidi Buhr; D. James Cooper; Craig Dicker; Eddy Fan; John F. Fraser; David Gattas; Ingrid K. Hopper; Sue Huckson; Natalie Linke; Ed Litton; Shay P. McGuinness; Priya Nair; Neil Orford; Rachael Parke; Vincent Pellegrino; David Pilcher; Dion Stub; Andrew Udy; Benjamin Reddi; Tony Trapani; Annalie Jones; Alisa M. Higgins; Carol Hodgson; EXCEL Study Investigators and the International ECMO Network (ECMONet); Andrew Bersten; Shailesh Bihari; Joanne McIntyre; Xia Jin; Jennifer Holmes

doi:10.1016/j.ccrj.2024.08.006

Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

Atacan D. Ertugrul, Ary Serpa Neto, Bentley Fulcher, Anaïs Charles-Nelson, Michael Bailey, Aidan Burrell, Shannah Anderson, Stephen Bernard, Jasmin Board, Daniel Brodie, Heidi Buhr, D. James Cooper, Craig Dicker, Eddy Fan, John F. Fraser, David Gattas, Ingrid K. Hopper, Sue Huckson, Natalie Linke, Ed LittonShay P. McGuinness, Priya Nair, Neil Orford, Rachael Parke, Vincent Pellegrino, David Pilcher, Dion Stub, Andrew Udy, Benjamin Reddi, Tony Trapani, Annalie Jones, Alisa M. Higgins, Carol Hodgson, EXCEL Study Investigators and the International ECMO Network (ECMONet), Andrew Bersten, Shailesh Bihari, Joanne McIntyre, Xia Jin, Jennifer Holmes

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: 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.

Design, setting, and participants: 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).

Results: 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.

Conclusion: 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.

Original language	English
Pages (from-to)	262-270
Number of pages	9
Journal	Critical Care and Resuscitation
Volume	26
Issue number	4
Early online date	22 Nov 2024
DOIs	https://doi.org/10.1016/j.ccrj.2024.08.006
Publication status	Published - Dec 2024

Keywords

Acute respiratory distress syndrome (ARDS)
Anaesthesia and intensive care
Cardiac failure
Cardiac perfusion
Emergency medicine
Extracorporeal life support
Intensive care
Oxygen delivery
Respiratory function
Resuscitation

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Ertugrul, A. D., Neto, A. S., Fulcher, B., Charles-Nelson, A., Bailey, M., Burrell, A., Anderson, S., Bernard, S., Board, J., Brodie, D., Buhr, H., Cooper, D. J., Dicker, C., Fan, E., Fraser, J. F., Gattas, D., Hopper, I. K., Huckson, S., Linke, N., ... Holmes, J. (2024). Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months. Critical Care and Resuscitation, 26(4), 262-270. https://doi.org/10.1016/j.ccrj.2024.08.006

@article{d57e426b48d14a83bae9c6e1ae4f114b,

title = "Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months",

abstract = "Objective: 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. Design, setting, and participants: 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). Results: 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. Conclusion: 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.",

keywords = "Acute respiratory distress syndrome (ARDS), Anaesthesia and intensive care, Cardiac failure, Cardiac perfusion, Emergency medicine, Extracorporeal life support, Intensive care, Oxygen delivery, Respiratory function, Resuscitation",

author = "Ertugrul, {Atacan D.} and Neto, {Ary Serpa} and Bentley Fulcher and Ana{\"i}s Charles-Nelson and Michael Bailey and Aidan Burrell and Shannah Anderson and Stephen Bernard and Jasmin Board and Daniel Brodie and Heidi Buhr and Cooper, {D. James} and Craig Dicker and Eddy Fan and Fraser, {John F.} and David Gattas and Hopper, {Ingrid K.} and Sue Huckson and Natalie Linke and Ed Litton and McGuinness, {Shay P.} and Priya Nair and Neil Orford and Rachael Parke and Vincent Pellegrino and David Pilcher and Dion Stub and Andrew Udy and Benjamin Reddi and Tony Trapani and Annalie Jones and Higgins, {Alisa M.} and Carol Hodgson and {EXCEL Study Investigators and the International ECMO Network (ECMONet)} and Jamie Cooper and Emma Martin and Phoebe McCracken and Jayne Sheldrake and Shirley Vallance and Meredith Young and Rinaldo Bellomo and Glenn Eastwood and Andrew Hilton and Leah Peck and John Dyett and Stephanie Hunter and Cheelim Liew and Joshua Heard and Sebastian Lijo and Mary Nourse and Sumeet Rai and Manoj Singh and Hemanth Veerendra and Tina Xu and Jonathan Barrett and Kyle Brooks and Gabrielle Hanlon and Chris Allen and Samantha Bizzell and Ege Eroglu and Annamaria Palermo and Susan Pellicano and Andrew Bersten and Shailesh Bihari and Julia Brown and Sharon Comerford and Laura Grear and Joanne McIntyre and Xia Jin and Ubbo Wiersema and Dee Figures and Maimoonbe Gough and Julie Pitman and Mandy Tallott and James Winearls and Jorge Brieva and Madeleine Hopkins and Nanda Jayarman and Poulter, {Amber Louise} and Kate Quarello and Anders Aneman and Danielle Austin and Peter McCanny and Jennene Miller and Brendan Murfin and Yolanda Cox and Stephanie Guo and Yayha Shehabi and Amanda Brown and Pamela Butt and Rachel Bushell and Jayshree Lavana and Dawn Lockwood and India Pearce and Gavin Salt and Solomon Thambiraj and Meg Howard and Chris Joyce and Jason Meyer and James Walsham and Nerissa Brown and Kathleen Glasby and Stephanie O'Connor and Justine Rivett and Joannies Yap and Debra Bristow and Jason Pincus and Janine Stuart and James Anstey and Deborah Barge and Menoly Butler and Bradley Gebbie and Frances Bass and Pierre Janin and Naomi Hammond and Kieron Potger and Elizabeth Yarad and Ruaidhri Carey and Jennifer Coles and Richard Totaro and Matthew Anstey and Anthadene Endemann and Sarah Hardy and Roxana Popa and Stephen Richards and Lara Rock and Bradley Wibrow and Leanne Barbazza and Barry Dixon and Jennifer Holmes and Patricia Hurune and Yvette O'Brien and Hergen Buscher and Sally Newman and Claire Reynolds and Gail Henson and Siva Senthuran and April Win and Samantha Breguet and Michelle Horton and Joe McCaffrey and Jemma Trickey and Ashoke Bannerjee and Benjamin Davidson and Jenyfer Joy and Jing Kong",

year = "2024",

month = dec,

doi = "10.1016/j.ccrj.2024.08.006",

language = "English",

volume = "26",

pages = "262--270",

journal = "Critical Care and Resuscitation",

issn = "1441-2772",

publisher = "Australasian Academy of Critical Care Medicine",

number = "4",

}

Ertugrul, AD, Neto, AS, Fulcher, B, Charles-Nelson, A, Bailey, M, Burrell, A, Anderson, S, Bernard, S, Board, J, Brodie, D, Buhr, H, Cooper, DJ, Dicker, C, Fan, E, Fraser, JF, Gattas, D, Hopper, IK, Huckson, S, Linke, N, Litton, E, McGuinness, SP, Nair, P, Orford, N, Parke, R, Pellegrino, V, Pilcher, D, Stub, D, Udy, A, Reddi, B, Trapani, T, Jones, A, Higgins, AM, Hodgson, C, EXCEL Study Investigators and the International ECMO Network (ECMONet), Bersten, A , Bihari, S, McIntyre, J, Jin, X & Holmes, J 2024, 'Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months', Critical Care and Resuscitation, vol. 26, no. 4, pp. 262-270. https://doi.org/10.1016/j.ccrj.2024.08.006

TY - JOUR

T1 - Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

AU - Ertugrul, Atacan D.

AU - Neto, Ary Serpa

AU - Fulcher, Bentley

AU - Charles-Nelson, Anaïs

AU - Bailey, Michael

AU - Burrell, Aidan

AU - Anderson, Shannah

AU - Bernard, Stephen

AU - Board, Jasmin

AU - Brodie, Daniel

AU - Buhr, Heidi

AU - Cooper, D. James

AU - Dicker, Craig

AU - Fan, Eddy

AU - Fraser, John F.

AU - Gattas, David

AU - Hopper, Ingrid K.

AU - Huckson, Sue

AU - Linke, Natalie

AU - Litton, Ed

AU - McGuinness, Shay P.

AU - Nair, Priya

AU - Orford, Neil

AU - Parke, Rachael

AU - Pellegrino, Vincent

AU - Pilcher, David

AU - Stub, Dion

AU - Udy, Andrew

AU - Reddi, Benjamin

AU - Trapani, Tony

AU - Jones, Annalie

AU - Higgins, Alisa M.

AU - Hodgson, Carol

AU - EXCEL Study Investigators and the International ECMO Network (ECMONet)

AU - Cooper, Jamie

AU - Martin, Emma

AU - McCracken, Phoebe

AU - Sheldrake, Jayne

AU - Vallance, Shirley

AU - Young, Meredith

AU - Bellomo, Rinaldo

AU - Eastwood, Glenn

AU - Hilton, Andrew

AU - Peck, Leah

AU - Dyett, John

AU - Hunter, Stephanie

AU - Liew, Cheelim

AU - Heard, Joshua

AU - Lijo, Sebastian

AU - Nourse, Mary

AU - Rai, Sumeet

AU - Singh, Manoj

AU - Veerendra, Hemanth

AU - Xu, Tina

AU - Barrett, Jonathan

AU - Brooks, Kyle

AU - Hanlon, Gabrielle

AU - Allen, Chris

AU - Bizzell, Samantha

AU - Eroglu, Ege

AU - Palermo, Annamaria

AU - Pellicano, Susan

AU - Bersten, Andrew

AU - Bihari, Shailesh

AU - Brown, Julia

AU - Comerford, Sharon

AU - Grear, Laura

AU - McIntyre, Joanne

AU - Jin, Xia

AU - Wiersema, Ubbo

AU - Figures, Dee

AU - Gough, Maimoonbe

AU - Pitman, Julie

AU - Tallott, Mandy

AU - Winearls, James

AU - Brieva, Jorge

AU - Hopkins, Madeleine

AU - Jayarman, Nanda

AU - Poulter, Amber Louise

AU - Quarello, Kate

AU - Aneman, Anders

AU - Austin, Danielle

AU - McCanny, Peter

AU - Miller, Jennene

AU - Murfin, Brendan

AU - Cox, Yolanda

AU - Guo, Stephanie

AU - Shehabi, Yayha

AU - Brown, Amanda

AU - Butt, Pamela

AU - Bushell, Rachel

AU - Lavana, Jayshree

AU - Lockwood, Dawn

AU - Pearce, India

AU - Salt, Gavin

AU - Thambiraj, Solomon

AU - Howard, Meg

AU - Joyce, Chris

AU - Meyer, Jason

AU - Walsham, James

AU - Brown, Nerissa

AU - Glasby, Kathleen

AU - O'Connor, Stephanie

AU - Rivett, Justine

AU - Yap, Joannies

AU - Bristow, Debra

AU - Pincus, Jason

AU - Stuart, Janine

AU - Anstey, James

AU - Barge, Deborah

AU - Butler, Menoly

AU - Gebbie, Bradley

AU - Bass, Frances

AU - Janin, Pierre

AU - Hammond, Naomi

AU - Potger, Kieron

AU - Yarad, Elizabeth

AU - Carey, Ruaidhri

AU - Coles, Jennifer

AU - Totaro, Richard

AU - Anstey, Matthew

AU - Endemann, Anthadene

AU - Hardy, Sarah

AU - Popa, Roxana

AU - Richards, Stephen

AU - Rock, Lara

AU - Wibrow, Bradley

AU - Barbazza, Leanne

AU - Dixon, Barry

AU - Holmes, Jennifer

AU - Hurune, Patricia

AU - O'Brien, Yvette

AU - Buscher, Hergen

AU - Newman, Sally

AU - Reynolds, Claire

AU - Henson, Gail

AU - Senthuran, Siva

AU - Win, April

AU - Breguet, Samantha

AU - Horton, Michelle

AU - McCaffrey, Joe

AU - Trickey, Jemma

AU - Bannerjee, Ashoke

AU - Davidson, Benjamin

AU - Joy, Jenyfer

AU - Kong, Jing

PY - 2024/12

Y1 - 2024/12

N2 - Objective: 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. Design, setting, and participants: 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). Results: 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. Conclusion: 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.

AB - Objective: 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. Design, setting, and participants: 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). Results: 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. Conclusion: 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.

KW - Acute respiratory distress syndrome (ARDS)

KW - Anaesthesia and intensive care

KW - Cardiac failure

KW - Cardiac perfusion

KW - Emergency medicine

KW - Extracorporeal life support

KW - Intensive care

KW - Oxygen delivery

KW - Respiratory function

KW - Resuscitation

UR - http://www.scopus.com/inward/record.url?scp=85210093138&partnerID=8YFLogxK

U2 - 10.1016/j.ccrj.2024.08.006

DO - 10.1016/j.ccrj.2024.08.006

M3 - Article

AN - SCOPUS:85210093138

SN - 1441-2772

VL - 26

SP - 262

EP - 270

JO - Critical Care and Resuscitation

JF - Critical Care and Resuscitation

IS - 4

ER -

Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

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