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Does geography affect referral rates for extracorporeal membrane oxygenation in England?

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Introduction

Referral for ECMO has been demonstrated to reduce mortality in severe hypoxic respiratory failure [13]. The numbers of patients that undergo ECMO is still small and the service depends on timely referral from regional ICUs. There is evidence that intensivists' views on the role of ECMO are mixed [4]. The purpose of this study is to determine whether there are variations in the geographical distribution of patients that receive ECMO.

Methods

NHS England provided the home primary care trust (PCT) of all adult patients referred for ECMO for potentially reversible respiratory failure from 2008 to 2012. The referrals from each PCT were indexed to the population of each area to produce a referral rate per 1,000,000 people.

Results

See Figure 1. ECMO services have expanded rapidly in the last 5 years in England following the publication of evidence for its efficacy and concerns regarding an influenza pandemic. The referral rates for ECMO for severe hypoxic respiratory failure vary greatly around the country from 88 per 1,000,000 population in Leicester City to no referrals in 32 PCTs. Possible explanations could include: the distributions of swine flu around the country, referring doctors' beliefs about the efficacy of ECMO, local access to high-frequency oscillation ventilation and possible reluctance of teaching hospitals to refer to specialist centres. Further investigation to account for this variation appears indicated.

Figure 1
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(abstract P317)

Conclusion

The referral rates for ECMO vary greatly around the country.

References

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    Peek GJ, et al.: CESAR Trial Collaboration: Efficacy and economic assessment of Conventional Ventilatory Support Versus Extra-Corporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR): a multicentre randomised controlled trail. Lancet 2009, 374: 1351-1363. 10.1016/S0140-6736(09)61069-2

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    Noah MA, et al.: Referral to an extracorporeal membrane oxygenation centre and mortality among patients with severe 2009 influenza A(H1N1). JAMA 2011, 306: 1659-1668. 10.1001/jama.2011.1471

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    Davies A, et al.: Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza investigators. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009, 302: 1888-1895.

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    Stewart NI, et al.: Regionalisation of intensive care and extra-corporeal membrane oxygenation services in the UK: beliefs about the evidence, benefit and harm. J Intensive Care Med 2012, 13: 244-250.

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Author information

Correspondence to J Barnett.

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Barnett, J. Does geography affect referral rates for extracorporeal membrane oxygenation in England?. Crit Care 18, P317 (2014). https://doi.org/10.1186/cc13507

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Keywords

  • Influenza
  • Emergency Medicine
  • Geographical Distribution
  • Respiratory Failure
  • Teaching Hospital