Category: Professional Posters
Purpose: Extracorporeal life support (ECLS) provides advanced respiratory or cardiac support for patients who fail conventional life support therapies such as mechanical ventilation. There are two modalities of ECLS. Venovenous (VV) ECMO provides respiratory support and is indicated for hypoxic respiratory failure with mortality risk of 80% or greater. Venoarterial (VA) ECMO provides circulatory and respiratory support and is indicated for cardiogenic shock. In June 2017, Baptist Health Care launched the only ECMO center in Northwest Florida. The purpose of this study was to compare ECMO survival rates at Baptist during the inaugural year to national survival rates.
Methods: The institutional review board approved this retrospective chart review. All patients initiated on ECMO from July 1, 2017 to June 30, 2018 were included in this study. Baptist Health Care data was imported from local electronic health records (EHR) and analyzed in a spreadsheet utilizing pivot tables. EHR data collected included patient age, ECMO modality and duration, and date of expiration or discharge. National ECLS data was retrieved from the Extracorporeal Life Support Organization (ESLO) registry. Data collected from the registry included number and type of ECMO runs, duration, and survival by support mode from January 2014 to January 2019. The primary outcome was ECMO survival and survival to discharge or transfer at a community hospital compared with national survival rates.
Results: Baptist Health Care had a total of 13 runs of ECMO during its inaugural year of providing ECLS. Nine patients were initiated on VV ECMO for respiratory support and four patients on VA ECMO for circulatory support. The average age was 44 years, the youngest patient was 16 and the oldest was 75. The average run time was six days. The shortest successful run was three days and the longest was 16 days. Baptist VV ECMO survival rate was 78% (n= 7), and survival rate to discharge or transfer was 67% (n= 6). Comparatively, the national ECLS registry reported 7,793 pulmonary runs over a five-year period and the survival rate was 69% (n= 5,445), and survival rate to discharge or transfer was 60% (n= 4,732). An absolute difference of 9% and 7% respectively for pulmonary support. Baptist VA ECMO survival was 50% (n=2) and survival to discharge or transfer was also 50% (n=2). Comparatively, the national ECLS registry reported 9,711 runs and the survival rate was 58% (n= 5,703), and survival to discharge or transfer was 42% (n= 4,159). An absolute difference of 8% for both measures of cardiac support.
Conclusion: Baptist Health Care ECMO survival rates were comparable to ESLO national registry outcomes. This study validates ECLS programs can be established at a community hospital successfully. Effective implementation at similar facilities will provide easier accessibility to life saving ECMO services for patients in various geographical locations.