The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes

BACKGROUND/AIMS: The use of extracorporeal membrane oxygenation (ECMO) is spreading rapidly, with successful procedures reported in the ECMO for Severe Adult Respiratory failure (CESAR) trial and treatment of the H1N1 pandemic. However, ECMO is associated with a high mortality rate. This study aimed...

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Autores principales: Kim, Go-Woon, Koh, Younsuck, Lim, Chae-Man, Huh, Jin Won, Jung, Sung Ho, Kim, Joon Bum, Hong, Sang-Bum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Internal Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768527/
https://www.ncbi.nlm.nih.gov/pubmed/27017393
http://dx.doi.org/10.3904/kjim.2015.027
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author Kim, Go-Woon
Koh, Younsuck
Lim, Chae-Man
Huh, Jin Won
Jung, Sung Ho
Kim, Joon Bum
Hong, Sang-Bum
author_facet Kim, Go-Woon
Koh, Younsuck
Lim, Chae-Man
Huh, Jin Won
Jung, Sung Ho
Kim, Joon Bum
Hong, Sang-Bum
author_sort Kim, Go-Woon
collection PubMed
description BACKGROUND/AIMS: The use of extracorporeal membrane oxygenation (ECMO) is spreading rapidly, with successful procedures reported in the ECMO for Severe Adult Respiratory failure (CESAR) trial and treatment of the H1N1 pandemic. However, ECMO is associated with a high mortality rate. This study aimed to show that increased experience and improved teamwork through education may reduce the mortality rate associated with ECMO. METHODS: A retrospective study was performed. Data were collected from January 1, 2009, to December 31, 2011. The data were divided into two periods: 2009/2010 (period 1) and 2011 (period 2). The protocol and training program were applied during period 2. RESULTS: Seventy-six patients were included. The most common disease requiring ECMO support was pneumonia (43.4%). ECMO was applied within 7 days in 76.3% of patients. The primary outcomes, such as Intensive Care Unit (ICU) and hospital mortality rates, were higher during period 1 (91.3%) than period 2 (66.7%, p = 0.013). A multivariate analysis revealed that ECMO weaning failure was the only factor associated with ICU and hospital mortality (ICU mortality: hazard ratio [HR], 11.349; 95% confidence interval [CI], 1.281 to 100.505; p = 0.029; hospital mortality: HR, 17.976; 95% CI, 2.263 to 142.777; p = 0.006). CONCLUSIONS: The mortality rate associated with the ECMO procedure decreased following the ECMO training program. However, applying the training program to ECMO management is not an independent factor for the mortality rate. Further studies should be performed to help reduce the mortality rate associated with ECMO.
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spelling pubmed-57685272018-01-19 The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes Kim, Go-Woon Koh, Younsuck Lim, Chae-Man Huh, Jin Won Jung, Sung Ho Kim, Joon Bum Hong, Sang-Bum Korean J Intern Med Original Article BACKGROUND/AIMS: The use of extracorporeal membrane oxygenation (ECMO) is spreading rapidly, with successful procedures reported in the ECMO for Severe Adult Respiratory failure (CESAR) trial and treatment of the H1N1 pandemic. However, ECMO is associated with a high mortality rate. This study aimed to show that increased experience and improved teamwork through education may reduce the mortality rate associated with ECMO. METHODS: A retrospective study was performed. Data were collected from January 1, 2009, to December 31, 2011. The data were divided into two periods: 2009/2010 (period 1) and 2011 (period 2). The protocol and training program were applied during period 2. RESULTS: Seventy-six patients were included. The most common disease requiring ECMO support was pneumonia (43.4%). ECMO was applied within 7 days in 76.3% of patients. The primary outcomes, such as Intensive Care Unit (ICU) and hospital mortality rates, were higher during period 1 (91.3%) than period 2 (66.7%, p = 0.013). A multivariate analysis revealed that ECMO weaning failure was the only factor associated with ICU and hospital mortality (ICU mortality: hazard ratio [HR], 11.349; 95% confidence interval [CI], 1.281 to 100.505; p = 0.029; hospital mortality: HR, 17.976; 95% CI, 2.263 to 142.777; p = 0.006). CONCLUSIONS: The mortality rate associated with the ECMO procedure decreased following the ECMO training program. However, applying the training program to ECMO management is not an independent factor for the mortality rate. Further studies should be performed to help reduce the mortality rate associated with ECMO. The Korean Association of Internal Medicine 2018-01 2016-03-25 /pmc/articles/PMC5768527/ /pubmed/27017393 http://dx.doi.org/10.3904/kjim.2015.027 Text en Copyright © 2018 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Go-Woon
Koh, Younsuck
Lim, Chae-Man
Huh, Jin Won
Jung, Sung Ho
Kim, Joon Bum
Hong, Sang-Bum
The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title_full The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title_fullStr The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title_full_unstemmed The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title_short The effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
title_sort effect of an improvement of experience and training in extracorporeal membrane oxygenation management on clinical outcomes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768527/
https://www.ncbi.nlm.nih.gov/pubmed/27017393
http://dx.doi.org/10.3904/kjim.2015.027
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