An advanced form of life support that takes over for the failing hearts and lungs of critically ill patients saves lives. But for adults, the odds of surviving depend on which hospital provides the life-supporting treatment – with the best odds at ones that use the technique dozens of times a year, a new University of Michigan study finds.
That is the key finding of the first large study in patients of all ages, of a life-support technology called ECMO. Michigan researchers looked at data from 56,222 patients treated at 290 hospitals around the world over 25 years.
The use of ECMO to treat adults has risen exponentially in the last decade, and grown steadily in children, the authors—including the School of Public Health’s Dr. Kelley Kidwell, a research associate professor of biostatistics—report in the American Journal of Respiratory and Critical Care Medicine. Though ECMO has existed since the 1970s, its use has grown as technology has improved and its potential to save lives became known.
“As use of ECMO rises, it will be very valuable to understand how best to provide this care, because it’s resource-intensive and carries a high risk of complication and death,” says lead author Dr. Ryan Barbaro, a pediatric critical care specialist and clinical lecturer at the U-M Medical School.
The researchers hope their current and future work will lead to collaborative efforts to standardize ECMO care, and improve outcomes for ECMO patients everywhere.
Short for extracorporeal membrane oxygenation, ECMO is a complex treatment option that requires a team of doctors, nurses, specialists, and respiratory therapists working together around the clock for days or weeks to keep a patient alive. Because of its complexity and risk, ECMO is most often used as a last resort in patients suffering massive lung failure, heart failure, the effects of massive infection such as sepsis or pneumonia, trauma, or in newborns with major congenital defects.
Used only in intensive care units, the bedside ECMO machine or “circuit” pumps the patient’s blood out of the body through specialized tubes, and into a system that oxygenates and removes carbon dioxide from it before returning it to the body with enough force to keep it circulating. In short, the ECMO machine takes over the functions of the patient’s heart and lungs – giving them time to recover. But the treatment team must constantly guard against clots, infections and over-thinning of blood that could kill the patient.
The new study finds tremendous variation in survival rates between centers, even though for children and newborns those variations don’t map neatly to the number of ECMO patients treated. At some hospitals, 18 percent of newborn ECMO patients died, at others it was 50 percent. For children, death rates ranged from 25 percent to 66 percent. And for adults, they ranged from 33 percent to 92 percent.
The new finding that the volume of patients treated is associated with different odds of survival is just the tip of the iceberg, says Dr. Matthew M. Davis, co-senior author on the paper and director of the pediatric health services fellowship program in the Child Health Evaluation and Research (CHEAR) Unit.
“As more and more hospitals offer ECMO, we need to ensure that we apply the same rigor to studying and improving care that we do to other services for which volume and experience matter for patient survival and other outcomes,” says Dr. Davis, who is also a professor of health management and policy and the U-M School of Public Health. “By sharing what we learn about best practices, we can do our best as a healthcare system to achieve the best results for critically ill patients.”
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