PMID- 31230966
OWN - NLM
STAT- MEDLINE
DCOM- 20200908
LR  - 20200908
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 33
IP  - 11
DP  - 2019 Nov
TI  - A 266 Patient Experience of a Quaternary Care Referral Center for Extracorporeal 
      Membrane Oxygenation with Assessment of Outcomes for Transferred Versus In-House 
      Patients.
PG  - 3048-3053
LID - S1053-0770(19)30478-1 [pii]
LID - 10.1053/j.jvca.2019.05.017 [doi]
AB  - OBJECTIVE: Patients undergoing venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) require highly trained specialists and resources to be cared for 
      safely. Interestingly, comparisons of outcomes for patients cannulated for 
      VA-ECMO by outside institutions and transferred to referral centers for further 
      care versus those cannulated and taken care of in house at the referral center 
      have not been reported on a large scale. This study aimed to perform the first 
      comparison of these 2 populations based on the experience of a single quaternary 
      referral center. DESIGN: A retrospective chart review-based study in a single 
      quaternary care center of patients cannulated by referring institutions for 
      VA-ECMO then transferred versus patients who were cannulated in house was 
      performed to assess for a difference in survival (both of ECMO therapy and 
      survival to discharge). SETTING: Single quaternary academic referral center for 
      ECMO. PARTICIPANTS: All patients undergoing VA-ECMO who were at least 18 years 
      old from 2011-2018 (266 patients). INTERVENTION: None. MEASUREMENTS AND MAIN 
      RESULTS: The study comprised 215 patients cannulated for VA-ECMO in house and 51 
      patients cannulated by 17 different outside institutions then transferred. 
      Survival of the ECMO run for in-house patients (122/215) was 56.7% (95% 
      confidence interval [CI] 50.1-63.3), and survival of transferred patients (31/51) 
      for the ECMO run was 60.8% (95% CI 47.4-74.2; p = 0.58). Survival to discharge in 
      patients cannulated in house (82/215) was 38.1% (95% CI 31.6-44.6) and for 
      outside hospital transfers (24/51 patients) was 47.1% (95% CI 33.4-60.8; 
      p = 0.23). CONCLUSIONS: This retrospective chart review of 266 patients found no 
      difference in survival of the ECMO therapy or survival to discharge in patients 
      cannulated by other institutions and transferred versus those who were cannulated 
      in house. Even though analysis on the feasibility of transfer centers has been 
      performed extensively in patients with respiratory failure requiring venovenous 
      ECMO, minimal investigation has been performed in patients requiring VA-ECMO. 
      These results should be considered hypothesis-generating because larger sample 
      sizes are necessary to guide care of these patients more definitively.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Dalia, Adam A
AU  - Dalia AA
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine Massachusetts 
      General Hospital, Boston, MA. Electronic address: aadalia@mgh.harvard.edu.
FAU - Axtel, Andrea
AU  - Axtel A
AD  - Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, MA.
FAU - Villavicencio, Mauricio
AU  - Villavicencio M
AD  - Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, MA.
FAU - D'Allesandro, David
AU  - D'Allesandro D
AD  - Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, MA.
FAU - Shelton, Ken
AU  - Shelton K
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine Massachusetts 
      General Hospital, Boston, MA.
FAU - Cudemus, Gaston
AU  - Cudemus G
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine Massachusetts 
      General Hospital, Boston, MA.
FAU - Ortoleva, Jamel
AU  - Ortoleva J
AD  - Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 
      Boston, MA.
LA  - eng
PT  - Journal Article
DEP - 20190519
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
SB  - IM
CIN - J Cardiothorac Vasc Anesth. 2019 Nov;33(11):3054-3055. PMID: 31351876
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Massachusetts/epidemiology
MH  - Middle Aged
MH  - Patient Discharge/trends
MH  - *Patient Transfer
MH  - Prognosis
MH  - *Referral and Consultation
MH  - Respiratory Insufficiency/mortality/*therapy
MH  - Retrospective Studies
MH  - Survival Rate/trends
OTO - NOTNLM
OT  - extracorporeal life support
OT  - extracorporeal membrane oxygenation
OT  - outside hospital extracorporeal membrane oxygenation
OT  - transferred patients
EDAT- 2019/06/25 06:00
MHDA- 2020/09/09 06:00
CRDT- 2019/06/25 06:00
PHST- 2019/04/10 00:00 [received]
PHST- 2019/05/10 00:00 [revised]
PHST- 2019/05/13 00:00 [accepted]
PHST- 2019/06/25 06:00 [pubmed]
PHST- 2020/09/09 06:00 [medline]
PHST- 2019/06/25 06:00 [entrez]
AID - S1053-0770(19)30478-1 [pii]
AID - 10.1053/j.jvca.2019.05.017 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2019 Nov;33(11):3048-3053. doi: 
      10.1053/j.jvca.2019.05.017. Epub 2019 May 19.