• Atacan D Ertugrul, NetoAry SerpaASAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.School of Public Health and Preventive Medicine, Monash University, Australia.University of Melbourne, Parkville, Australia.Intensive Care Un, Bentley J Fulcher, Anaïs Charles-Nelson, Michael Bailey, BurrellAidan J CAJCAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.School of Public Health and Preventive Medicine, Monash University, Australia.Intensive Care Unit, Alfred Hospital, Melbourne, Australia., Shannah Anderson, Stephen Bernard, Jasmin V Board, Daniel Brodie, Heidi Buhr, D James Cooper, Craig Dicker, Eddy Fan, John F Fraser, David J Gattas, Ingrid K Hopper, Sue Huckson, Natalie J Linke, Edward Litton, Shay P McGuinness, Priya Nair, Neil Orford, Rachael L Parke, Vincent A Pellegrino, David V Pilcher, Dion Stub, Andrew A Udy, ReddiBenjamin A JBAJIntensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia., Tony V Trapani, Annalie Jones, Alisa M Higgins, Carol L Hodgson, and EXCEL Study Investigators and the International ECMO Network (ECMONet).
• Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
• Crit Care Resusc. 2024 Dec 1; 26 (4): 262270262-270.

ObjectiveExtracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.Design Setting And ParticipantsThis is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).ResultsOf 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65-1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66-1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37-5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.ConclusionThere was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.© 2024 The Authors.

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