Off-Hour ECLS Initiation Does Not Influence Mortality in Adults

Purpose Time of day, day of the week, and holidays have been shown to affect patient outcomes in some clinical contexts. The purpose of this study was to assess a relationship between mortality following extracorporeal life support (ECLS) initiation Methods A retrospective review of patients requiring ECLS for any indication between July 2013 and December 2017 at our tertiary referral center was conducted. Offhour times included nights (ECLS initiation between 19:01 and 06:59 hours), holidays (United States Federal holidays and weekends) or weekends alone. Regular working hours encompass all other times. Additionally, the influence of time of year by month was also investigated. Mortality was defined as death on ECLS and all-cause mortality 30 days after decannulation. Chi-square test for categorical variables was used to compare the groups Results 407 patients underwent 415 ECLS events during the study period. There were no significant differences in mortality when ECLS was initiated during offhour periods as compared to regular working hours. Sixty nine patients (45.1%) who were started on ECLS support at night died, as compared to 118 (45.0%) during daytime hours (p=0.49). Fifty patients (45.5%) in whom ECLS was commenced during a holiday died, as compared to 137 (44.9%) during nonholidays (p=0.46). Forty-five patients (45.5%) who were initiated on ECLS support during a weekend died, compared to 142 (44.9%) who were cannulated during a weekday (p=0.46). The month of the year also did not influence mortality (p=0.27) Conclusion No significant differences in mortality were observed among patients in whom ECLS support was initiated during off-hours compared to regular working hours, nor was it influenced by month of year. Our results support the notion that year-round availability of ECLS trained staff may guard against mortality during off-hours events