Retrieval of Adult Patients on Extracorporeal Membrane Oxygenation by an Intensive Care Physician Model. Issue 3 (19th November 2017)

• Record Type: Journal Article
• Authors: Burrell, Aidan J. C.; Pilcher, David V.; Pellegrino, Vincent A.; Bernard, Stephen A.
• Is Part Of: Artificial organs. Volume 42:Issue 3(2018)
• Page Start: 254
• Page End: 262
• Publication Date: 2017-11-19
• Subjects: Extracorporeal membrane oxygenation -- —respiratory failure -- —cardiac failure -- —retrieval -- —interhospital transportation -- —long term outcomes; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13010
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: The optimal staffing model during the inter‐hospital transfer of patients on extracorporeal membrane oxygenation (ECMO) is not known. We report the complications and outcomes of patients who were commenced on ECMO at a referring hospital by intensive care physicians and compare these findings with patients who had ECMO established at an ECMO center in Australia. This was a single center, retrospective observational study based on a prospectively collected ECMO database from Melbourne, Australia. Patients with severe cardiac and/or respiratory failure failing conventional supportive treatment between 2007–2013 were placed on ECMO via a physician‐led model of ECMO retrieval, including two intensivists in a four person team, using percutaneous ECMO cannulation. Patients (198) underwent ECMO over the study period, of which 31% were retrieved. Veno‐venous (VV)‐ECMO and veno‐arterial (VA)‐ECMO accounted for 27 and 73% respectively. The VA‐ECMO patients had more intra‐transport interventions compared with VV‐ECMO transported patients, but none resulting in serious morbidity or death. There was no overall difference in survival at 6 months between retrieved and ECMO center patients: VV‐ECMO (75 vs. 70%, P = 0.690) versus VA‐ECMO (70 vs. 68%, P = 1.000). An intensive care physician‐led team was able to safely place all critically ill patients on ECMO and retrieve them to an ECMO center. This may be an appropriate staffing model for ECMO retrieval.