A phased intervention bundle to decrease the mortality of patients with extracorporeal membrane oxygenation in intensive care unit

Abstract

AimTo evaluate whether a phased multidimensional intervention bundle would decrease the mortality of patients with extracorporeal membrane oxygenation (ECMO) and the complication incidence.Materials and methodsWe conducted a prospective observational study in comparison with a retrospective control group in six intensive care units (ICUs) in China. Patients older than 18 years supported with ECMO between March 2018 to March 2022 were included in the study. A phased intervention bundle to improve the outcome of patients with ECMO was developed and implemented. Multivariable logistic regression modeling was used to compare the mortality of patients with ECMO and the complication incidence before, during, and up to 18 months after implementation of the intervention bundle.ResultsThe cohort included 297 patients in 6 ICUs, mostly VA ECMO (68.7%) with a median (25th–75th percentile) duration in ECMO of 9.0 (4.0–15.0) days. The mean (SD) APECHII score was 24.1 (7.5). Overall, the mortality of ECMO decreased from 57.1% at baseline to 21.8% at 13–18 months after implementation of the study intervention (P < 0.001). In multivariable analysis, even after excluding the confounding factors, such as age, APECHII score, pre-ECMO lactate, and incidence of CRRT during ECMO, the intervention bundle still can decrease the mortality independently, which also remained true in the statistical analysis of V-V and V-A ECMO separately. Among all the ECMO-related complications, the incidence of bloodstream infection and bleeding decreased significantly at 13–18 months after implementation compared with the baseline. The CUSUM analysis revealed a typical learning curve with a point of inflection during the implementation of the bundle.ConclusionA phased multidimensional intervention bundle resulted in a large and sustained reduction in the mortality of ECMO that was maintained throughout the 18-month study period.Clinical trial registration[ClinicalTrials.gov], identifier [NCT05024786].

Implementation of the Kidney Disease Improving Global Outcomes guidelines for the prevention of acute kidney injury after cardiac surgery

“…18 In critical care, intervention bundles have been developed for various conditions such as mechanical ventilation, delirium, or the treatment of sepsis. 15,19,20 However, poor compliance in clinical practice remains a well recognised problem, declining even further as the number of elements to be implemented increases. 14,21,22 As the KDIGO care bundle consists of no less than six different measures, the implementation of the complete bundle is apparently difficult to establish.…”

“…These combined interventions are considered to improve patient outcomes more effectively than individual implementation of single measures alone 18 . In critical care, intervention bundles have been developed for various conditions such as mechanical ventilation, delirium, or the treatment of sepsis 15,19,20 …”

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

“…To keep pace with the rising need for ECMO, high-volume ECMO centers have embraced a multidisciplinary approach and proven techniques aimed at preventing complications, enhancing survival rates, and improving overall patient outcomes [2][3][4]. However, despite numerous advancements in the field, the mortality and morbidity rates for ECMO patients persist at elevated levels [5,6].…”