Impact of the location of the initial admitting intensive care unit on the delivery of extracorporeal membrane oxygenation in Australia and New Zealand.
C Jake D Barlow, Alastair J Brown, Tess Evans, David A Sidebotham, David V Pilcher
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引用次数: 0
Abstract
Extracorporeal membrane oxygenation (ECMO) is a method of life support provided in a limited number of (typically centralised) intensive care units (ICUs) which may lead to inequity in the delivery of ECMO. We conducted a retrospective cohort study of all ICU admissions in Australia and New Zealand reported to the Australian and New Zealand Intensive Care Society Adult Patient Database between 2018 and 2022. We performed descriptive and propensity-matched analyses to determine how healthcare jurisdiction, remoteness, and initial admitting hospital type (based on ECMO capability) affected the chance of receiving ECMO. There were 703,529 patients at 199 hospitals who met inclusion criteria, of whom 1654 (0.2%) received ECMO. After propensity matching, patients had a reduced odds of receiving ECMO if admitted in the Australian Capital Territory (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.34 to 0.86), New Zealand (OR 0.42, 95% CI 0.26 to 0.67), Northern Territory (OR 0.29, 95% CI 0.1 to 0.86), Queensland (OR 0.53, 95% CI 0.45 to 0.63) or Western Australia (OR 0.46, 95% CI 0.35 to 0.62) compared with New South Wales. Patients from Outer Regional areas were less likely to receive ECMO than those residing in a Major City (OR 0.77, 95% CI 0.63 to 0.94). Initial admission in a non-ECMO centre was associated with reduced odds of receiving ECMO (OR 0.60, 95% CI 0.52 to 0.69), whilst initial admission in a Major ECMO centre was associated with increased odds of receiving ECMO (OR 2.03, 95% CI 1.78 to 2.31), compared with Minor ECMO centres. Our study suggests there is inequity in the delivery of ECMO in Australia and New Zealand, which should inform policy and planning for ECMO provision throughout the region.
体外膜氧合(ECMO)是在有限数量的(通常是集中的)重症监护病房(icu)中提供的一种生命支持方法,这可能导致ECMO的交付不公平。我们对2018年至2022年澳大利亚和新西兰重症监护协会成人患者数据库中报告的澳大利亚和新西兰所有ICU入院患者进行了回顾性队列研究。我们进行了描述性和倾向匹配分析,以确定医疗管辖区、偏远地区和最初入院的医院类型(基于ECMO能力)如何影响接受ECMO的机会。199家医院的703,529例患者符合纳入标准,其中1654例(0.2%)接受了ECMO。倾向匹配后,与新南威尔士州相比,在澳大利亚首都地区(优势比(OR) 0.54, 95%可信区间(CI) 0.34至0.86)、新西兰(OR 0.42, 95% CI 0.26至0.67)、北领地(OR 0.29, 95% CI 0.1至0.86)、昆士兰(OR 0.53, 95% CI 0.45至0.63)或西澳大利亚(OR 0.46, 95% CI 0.35至0.62)住院的患者接受ECMO的几率降低。来自外部地区的患者接受ECMO的可能性低于居住在主要城市的患者(OR 0.77, 95% CI 0.63至0.94)。与次要ECMO中心相比,首次入住非ECMO中心与接受ECMO的几率降低相关(OR 0.60, 95% CI 0.52至0.69),而首次入住主要ECMO中心与接受ECMO的几率增加相关(OR 2.03, 95% CI 1.78至2.31)。我们的研究表明,在澳大利亚和新西兰,ECMO的提供存在不公平,这应该为整个地区ECMO提供的政策和规划提供信息。
期刊介绍:
Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine.