Potential to prevent deaths in Ballarat if immediate access to ECMO were available.

Abstract

Background

Extracorporeal Membrane Oxygenation (ECMO) is a form of mechanical cardiopulmonary support that can be initiated in patients with refractory cardiogenic shock, respiratory failure, or even refractory cardiac arrest (E-CPR). However, ECMO is only available in specialist centres - therefore patients requiring ECMO outside of these centres need to be retrieved, and often ECMO cannot be initiated until the arrival of an external specialist team. There can be significant time delays in this, particularly if the patient is located in a regional centre.

Objectives/Aims

To determine the number of deaths within Ballarat that potentially may have been prevented if ECMO could be immediately initiated within Ballarat Health Services (BHS).

Method

We performed a retrospective audit of deaths that occurred within the critical areas of BHS (ICU, Emergency Department and Cardiac Catheter Laboratory) to determine how many patients may have been candidates for ECMO, over a two year period from April 1st 2017 to March 31st 2019. We also performed an audit of deaths from out of hospital cardiac arrest within 30km of the hospital over the same two year period to determine how many may have been candidates for E-CPR.

Results

We identified a total of 21 patients over the two years – six within hospital and 15 who suffered refractory out of hospital cardiac arrest. The average age of these patients was 49 years (range 25 to 65).

Implications/Outcomes for Planned Research Project

There is a small but significant number of people within Ballarat who may be saved if they can be rapidly commenced on ECMO.

Final Thoughts

Regional centres will need to develop models of care in conjunction with tertiary centres in order to provide timely access to ECMO to all patients.