Regional access to a centralized extracorporeal membrane oxygenation (ECMO) service in Victoria, Australia

IF 1.4 4区 医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-03-01 DOI:10.1016/j.ccrj.2023.11.007
Joanna WY. Chow MBBS , John F. Dyett MBBS , Steve Hirth MIT , Julia Hart MD , Graeme J. Duke MBBS, MD
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引用次数: 0

Abstract

Introduction

Victoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described.

Objective

Describe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access.

Design

Retrospective observational study with spatial mapping.

Participants and setting

Adult (≥18 years) ECMO recipients from July 2016–June 2022. Data from administrative Victorian Admissions Episodes Database analysed in conjunction with Australian Urban Research Infrastructure Network population data and choropleth mapping. Presumed ECMO modes were inferred from cardiopulmonary bypass and pre-hospital cardiac arrest codes. Spatial autoregressive models including Moran's test used for spatial lag testing.

Outcomes

Demographics and outcomes of ECMO recipients; ECMO incidence by patient residence (Statistical-Area Level 2, SA-2) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD); and ECMO utilisation adjusted for patient factors and linear distance from the central ECMO referral site.

Results

631 adults received ECMO over 6 years, after exclusion of paediatric (n = 242), duplicate (n = 135), and interstate or incomplete (n = 72) records. Mean age was 51.8 years, and 68.8 % were male. Overall ECMO incidence was 3.00 ± 3.95 per 105 population. 135 (21.4 %) were presumed VA-ECMO, 59 (9.3 %) presumed ECPR, and 437 (69.3 %) presumed VV-ECMO. Spatial lag was non-significant after adjusting for patient characteristics. Distance from the central referral site (dy/dx = 0.19, 95% CI −0.41–0.04, p = 0.105) and IRSAD score (dy/dx = 0.17, 95% CI −0.19–0.53, p = 0.359) did not predict ECMO utilisation.

Conclusion

Victorian ECMO incidence rates were low. We did not find evidence of inequity of access to ECMO irrespective of regional area or socioeconomic status.

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澳大利亚维多利亚州集中式体外膜肺氧合(ECMO)服务的区域准入情况
澳大利亚维多利亚州提供集中的州立 ECMO 服务,并由救护车提供支持。目标描述 ECMO 接受者的特征,并量化地理和社会经济因素对接受 ECMO 的影响。参与者和环境2016 年 7 月至 2022 年 6 月期间接受 ECMO 的成人(≥18 岁)。数据来自维多利亚州入院病例行政数据库,结合澳大利亚城市研究基础设施网络的人口数据和choropleth绘图进行分析。根据心肺旁路和院前心脏骤停代码推断 ECMO 模式。结果ECMO接受者的人口统计学特征和结果;按患者居住地(二级统计区,SA-2)和社会经济相对优势和劣势指数(IRSAD)划分的ECMO发生率;以及根据患者因素和与ECMO中心转诊地点的线性距离调整后的ECMO利用率。结果 631 名成人在 6 年内接受了 ECMO,排除了儿科(242 人)、重复(135 人)、州际或不完整(72 人)记录。平均年龄为 51.8 岁,68.8% 为男性。每 105 人中 ECMO 的总发生率为 3.00 ± 3.95。135例(21.4%)推测为VA-ECMO,59例(9.3%)推测为ECPR,437例(69.3%)推测为VV-ECMO。调整患者特征后,空间滞后并不显著。与中心转诊地点的距离(dy/dx = 0.19,95% CI -0.41-0.04,p = 0.105)和 IRSAD 评分(dy/dx = 0.17,95% CI -0.19-0.53,p = 0.359)不能预测 ECMO 的使用情况。无论地区或社会经济状况如何,我们都没有发现 ECMO 使用不公平的证据。
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来源期刊
Critical Care and Resuscitation
Critical Care and Resuscitation CRITICAL CARE MEDICINE-
CiteScore
7.70
自引率
3.40%
发文量
44
审稿时长
>12 weeks
期刊介绍: ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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