The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes

다국어 초록 (Multilingual Abstract)

Background/Aims: The use of extracorporeal membrane oxygenation (ECMO) is spreading rapidly, with successful procedures reported in the ECMO for Severe Adult Respiratory failure (CESAR) trial and treatment of the H1N1 pandemic. However, ECMO is associated with a high mortality rate. This study aimed to show that increased experience and improved teamwork through education may reduce the mortality rate associated with ECMO.
Methods: A retrospective study was performed. Data were collected from January 1, 2009, to December 31, 2011. The data were divided into two periods: 2009/2010 (period 1) and 2011 (period 2). The protocol and training program were applied during period 2.
Results: Seventy-six patients were included. The most common disease requiring ECMO support was pneumonia (43.4%). ECMO was applied within 7 days in 76.3% of patients. The primary outcomes, such as Intensive Care Unit (ICU) and hospital mortality rates, were higher during period 1 (91.3%) than period 2 (66.7%, p = 0.013). A multivariate analysis revealed that ECMO weaning failure was the only factor associated with ICU and hospital mortality (ICU mortality: hazard ratio [HR], 11.349; 95% confidence interval [CI], 1.281 to 100.505; p = 0.029; hospital mortality: HR, 17.976; 95% CI, 2.263 to 142.777; p = 0.006).
Conclusions: The mortality rate associated with the ECMO procedure decreased following the ECMO training program. However, applying the training program to ECMO management is not an independent factor for the mortality rate. Further studies should be performed to help reduce the mortality rate associated with ECMO.

참고문헌 (Reference)

1 The Acute Respiratory Distress Syndrome Network, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" 342 : 1301-1308, 2000

2 Gattinoni L, "Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of $CO_2$" 2 : 292-294, 1980

3 Terragni PP, "Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal" 111 : 826-835, 2009

4 Young MP, "The impact of a multidisciplinary approach on caring for ventilator-dependent patients" 10 : 15-26, 1998

5 Anderson JM, "Simulating extracorporeal membrane oxygenation emergencies to improve human performance. Part I: methodologic and technologic innovations" 1 : 220-227, 2006

6 Kurusz M, "Risk containment during cardiopulmonary bypass" 2 : 400-409, 1990

7 Marasco SF, "Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients" 17 (17): S41-S47, 2008

8 Noah MA, "Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1)" 306 : 1659-1668, 2011

9 Mercat A, "Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial" 299 : 646-655, 2008

10 Pronovost PJ, "Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review" 288 : 2151-2162, 2002

11 Pronovost PJ, "Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery" 281 : 1310-1317, 1999

12 Fleming GM, "Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006" 10 : 439-444, 2009

13 Bellani G, "Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury" 183 : 1193-1199, 2011

14 Halm EA, "Is volume related to outcome in health care? A systematic review and methodologic critique of the literature" 137 : 511-520, 2002

15 Burton KS, "Impact of simulation-based extracorporeal membrane oxygenation training in the simulation laboratory and clinical environment" 6 : 284-291, 2011

16 Kahn JM, "Hospital volume and the outcomes of mechanical ventilation" 355 : 41-50, 2006

17 Abdelsalam M, "Goal-directed therapy for severely hypoxic patients with acute respiratory distress syndrome: permissive hypoxemia" 55 : 1483-1490, 2010

18 Bastin AJ, "Extracorporeal membrane oxygenation for severe acute respiratory failure in adults: NICE guidance" 97 : 1701-1703, 2011

19 Brodie D, "Extracorporeal membrane oxygenation for ARDS in adults" 365 : 1905-1914, 2011

20 Australia, "Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome" 302 : 1888-1895, 2009

21 Paden ML, "Extracorporeal Life Support Organization Registry Report 2012" 59 : 202-210, 2013

22 Thiara AP, "Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation" 22 : 323-326, 2007

23 Peek GJ, "Efficacy and economic assessment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial" 374 : 1351-1363, 2009

24 Extracorporeal Life Support Organization, "ELSO General Guidelines [Internet]" ELSO

25 Lecuyer L, "Case volume and mortality in haematological patients with acute respiratory failure" 32 : 748-754, 2008

26 Showstack JA, "Association of volume with outcome of coronary artery bypass graft surgery: scheduled vs nonscheduled operations" 257 : 785-789, 1987

27 Grasselli G, "A case of ARDS associated with influenza A: H1N1 infection treated with extracorporeal respiratory support" 75 : 741-745, 2009