ECMO Retrieval; Factors Influencing ICU Discharge Outcomes
Lucy Kennedy / Scott Wrigley
Adult Retrieval Victoria, Australia, University of Melbourne Medical School, Australia
Lucy Kennedy is a third year medical student at the University of Melbourne, with an undergraduate degree in Biomedicine from the University of Melbourne.
Scott Wrigley is a final year medical student at the University of Melbourne, with an undergraduate degree in Biomedicine from the University of Melbourne.
Adult Retrieval Victoria (ARV) and the Alfred Hospital currently provide collaborative Veno-Arterial (VA) and Veno-Venous (VV) ECMO retrieval services to Victoria, Tasmania and South Australia. To date, there has been no investigation of an association between factors occurring within the patient retrieval process, and impact on clinical outcomes.
Through a retrospective cohort analysis of 88 ARV ECMO retrievals from January 2014 to December 2017 inclusive, this study aimed to describe and review the current ECMO retrieval service operating in Victoria, Australia in terms of delivering acceptable patient outcomes. The primary clinical outcome was defined as patient survival to ICU discharge. Retrieval transport is by road (n=76) and fixed-wing aircrafts (n=12), from metropolitan and regional hospitals.
The key finding of this study is a clear association between complications occurring during VA ECMO transfer and decreased survival to ICU discharge (Χ2=6.27, p=0.012). Overall, the mortality rate for VA ECMO patients was greater than that of VV ECMO patients. There was an increased risk of mortality prior to ICU discharge in patients retrieved from metro-areas when compared to those retrieved from regional centres. Patients retrieved through VA and VV ECMO were inherently found to carry high clinical-risk with a median REMS of 8. Patients not surviving to ICU discharge (VA median = 58, VV median = 43) were significantly older than the survival cohort (VA median = 49, VV median = 39).
ECMO retrieval is known to be a high-risk process, however, it can be conducted safely with appropriate specialised care. This study highlights the importance of risk awareness and mitigation during retrieval transfer, and similarly the necessity for retrieval and ECMO initiation expertise.
There was no financial interest/arrangement or direct affiliation with any corporate entity with interests in the subject matter.