Cardiac Extracorporeal Membrane Oxygenation in Community Cardiac Surgery Program: Are the Results Comparable?

Area of Science:

• Cardiovascular Medicine
• Critical Care Medicine
• Extracorporeal Life Support

Background:

• Outcomes for extracorporeal membrane oxygenation (ECMO) are often perceived as less favorable in smaller centers compared to high-volume institutions.
• A regional community hospital system implemented new ECMO protocols and procedures as part of a cardiogenic shock initiative.
• This initiative aimed to improve outcomes for patients requiring veno-arterial ECMO (VA ECMO) and extracorporeal cardiopulmonary resuscitation (ECPR).

Purpose of the Study:

• To evaluate the outcomes of VA ECMO and ECPR within a community hospital system possessing cardiac surgery capabilities.
• To assess if optimized protocols and cannulation standards lead to outcomes comparable to those of larger, established ECMO centers.
• To determine if the new ECMO program's results align with United States national averages.

Main Methods:

• A retrospective analysis of cardiac ECMO cases from May 2021 to April 2023 was conducted within a five-hospital regional system.
• The system's single hospital with cardiac surgery and ECMO capability initiated the program in May 2021.
• Patients requiring VA ECMO for cardiogenic shock or ECPR were screened, cannulated by a dedicated ECMO team, and treated according to established protocols.

Main Results:

• A total of 60 patients underwent cardiac ECMO, with 18 (30%) requiring ECPR.
• Overall survival was 48% (29/60); VA ECMO (excluding ECPR) survival was 50% (22/42), and ECPR survival was 39% (7/18).
• Hospital survival rates for VA ECMO (36%) and ECPR (28%) were comparable to ELSO-reported national averages (48% and 30%, respectively).

Conclusions:

• Optimized protocols, standardized cannulation, and expert ECMO management in a community hospital setting can yield outcomes comparable to larger centers.
• The study demonstrates that a community hospital system with cardiac surgery capability can achieve non-inferior VA ECMO results.
• These findings challenge the notion that smaller centers inherently have less favorable ECMO outcomes.