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

Atacan D Ertugrul^{1

2}, Ary Serpa Neto^{1

2

3

4

5}, Bentley J Fulcher^{1

2}, Anaïs Charles-Nelson^{1

2}, Michael Bailey^{1

2}, Aidan J C Burrell^{1

2

6}, Shannah Anderson¹, Stephen Bernard^{2

6}, Jasmin V Board⁶, Daniel Brodie⁷, Heidi Buhr⁸, D James Cooper^{1

2

6}, Craig Dicker^{1

2}, Eddy Fan⁹, John F Fraser^{10

11}, David J Gattas⁸, Ingrid K Hopper², Sue Huckson¹², Natalie J Linke^{1

2}, Edward Litton¹³, Shay P McGuinness^{1

14

15}, Priya Nair¹⁶, Neil Orford^{1

17

18}, Rachael L Parke^{1

14

15}, Vincent A Pellegrino⁶, David V Pilcher^{1

6}, Dion Stub^{2

6}, Andrew A Udy^{1

2

6}, Benjamin A J Reddi¹⁹, Tony V Trapani^{1

2}, Annalie Jones⁶, Alisa M Higgins^{1

2}, Carol L Hodgson^{1

2

3

6}; EXCEL Study Investigators and the International ECMO Network (ECMONet)

Collaborators, Affiliations

Collaborators

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

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
² School of Public Health and Preventive Medicine, Monash University, Australia.
³ University of Melbourne, Parkville, Australia.
⁴ Intensive Care Unit, Austin Hospital, Melbourne, Australia.
⁵ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Intensive Care Unit, Alfred Hospital, Melbourne, Australia.
⁷ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, Australia.
⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ University of Queensland, St Lucia, Australia.
¹¹ Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Chermside, Australia.
¹² Australian and New Zealand Intensive Care Society, Melbourne, Australia.
¹³ Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Australia.
¹⁴ Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁵ Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
¹⁶ Intensive Care Unit, St Vincent's Hospital, Darlinghurst, Australia.
¹⁷ Intensive Care Unit, University Hospital Geelong, Geelong, Australia.
¹⁸ School of Medicine, Deakin University, Geelong Waurn Ponds, Australia.
¹⁹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.

PMID: 39781494
PMCID: PMC11704083
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 et al. Crit Care Resusc. 2024.

. 2024 Nov 22;26(4):262-270.

doi: 10.1016/j.ccrj.2024.08.006. eCollection 2024 Dec.

Authors

Collaborators

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

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
² School of Public Health and Preventive Medicine, Monash University, Australia.
³ University of Melbourne, Parkville, Australia.
⁴ Intensive Care Unit, Austin Hospital, Melbourne, Australia.
⁵ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Intensive Care Unit, Alfred Hospital, Melbourne, Australia.
⁷ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, Australia.
⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ University of Queensland, St Lucia, Australia.
¹¹ Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Chermside, Australia.
¹² Australian and New Zealand Intensive Care Society, Melbourne, Australia.
¹³ Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Australia.
¹⁴ Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁵ Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
¹⁶ Intensive Care Unit, St Vincent's Hospital, Darlinghurst, Australia.
¹⁷ Intensive Care Unit, University Hospital Geelong, Geelong, Australia.
¹⁸ School of Medicine, Deakin University, Geelong Waurn Ponds, Australia.
¹⁹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.

PMID: 39781494
PMCID: PMC11704083
DOI: 10.1016/j.ccrj.2024.08.006

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.

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Conflict of interest statement

Carol L Hodgson reports financial support was provided by National Health and Medical Research Council. Carol L Hodgson reports financial support was provided by National Heart Foundation of Australia. Ary Serpa-Neto, Bentley J Fulcher, Anais Charles-Nelson, Michael J Bailey, Stephen Bernard, Aidan JC Burrell, D. James Cooper, David J Gattas, Ingrid K Hopper, David V Pilcher, Natalie J Linke, Tony V Trapani, Alisa M. Higgins reports financial support was provided by National Health and Medical Research Council. Ary Serpa-Neto, Bentley J Fulcher, Anais Charles-Nelson, Michael J Bailey, Stephen Bernard, Aidan JC Burrell, D. James Cooper, Daivd J Gattas, Ingrid K Hopper, David V Pilcher, Natalie J Linke, TOny V Trapani, Alisa M Higgins reports financial support was provided by National Heart Foundation of Australia. Carol L Hodgson reports a relationship with National Health and Medical Research Council that includes: funding grants. Carol L Hodgson reports a relationship with International ECMO Network (ECMONet) that includes: board membership. Carol L Hodgson, Ary Serpa Neto, Edward Litton, D. James Cooper, Andrew Udy reports a relationship with Critical Care and Resuscitation that includes: editorial team membership as associate editors. Alisa M Higgins, Aidan JC Burrell, D. James Cooper reports a relationship with National Health and Medical Research Council that includes: funding grants. Daniel Brodie, Eddy Fan, John F Fraser, Vincent A Pellegrino reports a relationship with International ECMO Network (ECMONet) that includes: board membership. Daniel Brodie, Eddy Fan, John F Fraser reports a relationship with Extracorporeal Life Support Organization that includes: board membership. Daniel Brodie reports a relationship with AbioMed Inc that includes: board membership. Daniel Brodie reports a relationship with Xenios AG that includes: board membership. Daniel Brodie reports a relationship with Medtronic Inc that includes: board membership. Daniel Brodie reports a relationship with Cellenkos that includes: board membership. Daniel Brodie reports a relationship with Alung Technologies that includes: funding grants. John F Fraser reports a relationship with Queensland Cardiovascular Research Network that includes: board membership. John F Fraser reports a relationship with BiVACOR that includes: board membership. John F Fraser reports a relationship with Xenios AG that includes: funding grants. John F Fraser reports a relationship with Mallenkrodt Getinge that includes: funding grants. John F Fraser reports a relationship with MERA that includes: funding grants. Dion Stub reports a relationship with National Heart Foundation of Australia that includes: funding grants. Andrew A Udy reports a relationship with Australian and New Zealand Intensive Care Society Clinical Trials Group that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Flow diagram of patient exclusion and ECMO mode split from raw data set.

See this image and copyright information in PMC

References

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Full Text Sources