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Extracorporeal Membrane Oxygenation and Interfacility Transfer: A Regional Referral Experience
- Source :
- The Annals of thoracic surgery. 104(5)
- Publication Year :
- 2016
-
Abstract
- Background The number of adults referred to high-volume centers for extracorporeal membrane oxygenation (ECMO) is increasing. Outcomes of patients requiring transport are not well characterized, and referral guidelines are lacking. This study describes the experience and outcomes of a single high-volume center. Methods A retrospective study was performed that included adults undergoing ECMO between June 2009 and December 2015. Patient characteristics and outcomes were acquired from the medical record. Logistic regression was used to identify predictors of survival to hospital discharge. The Kaplan-Meier method was used to depict rates of survival. Results Of 133 patients, 77 (57.9%) underwent venoarterial (VA) ECMO and 56 (42.1%) underwent venovenous (VV) ECMO. Median transport distance was 88.8 miles (range 0.2–1,434 miles). Median duration of support was 6 days (range, 1–32.5 days). Age older than 60 years, pulmonary hypertension, and body mass index (BMI) greater than 30 were associated with worse survival to discharge for VA ECMO; a history of hypertension and presence of left ventricular (LV) vent were associated with better survival. Age older than 60 years and diabetes were associated with worse survival to hospital discharge for VV ECMO. Survival to decannulation was 66.2% and 76.8%, and to hospital discharge it was 48.1% and 69.6% for VA and VV ECMO, respectively. Of hospital survivors, Kaplan-Meier estimates of 1-year survival were 82.4% and 95.5% for VA and VV, respectively. Conclusions Outcomes are favorable after transport to high-volume ECMO centers. Guidelines and infrastructure for short- and long-distance ECMO transport is imperative for the efficient and successful management of these patients.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
Patient Transfer
medicine.medical_specialty
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Risk Assessment
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Extracorporeal Membrane Oxygenation
Predictive Value of Tests
Cause of Death
Extracorporeal membrane oxygenation
medicine
North Carolina
Humans
Hospital Mortality
Referral and Consultation
Survival analysis
Cause of death
Aged
Retrospective Studies
Analysis of Variance
Respiratory Distress Syndrome
business.industry
Medical record
Retrospective cohort study
Length of Stay
Middle Aged
Survival Analysis
Surgery
surgical procedures, operative
Logistic Models
030228 respiratory system
Predictive value of tests
Multivariate Analysis
Disease Progression
Female
Cardiology and Cardiovascular Medicine
business
Body mass index
Hospitals, High-Volume
Cohort study
Follow-Up Studies
Subjects
Details
- ISSN :
- 15526259
- Volume :
- 104
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....82dc555e32a715f9f3e14e8dab04828d