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Article: Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong

TitleTen-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong
Authors
Issue Date16-Nov-2023
PublisherHong Kong Academy of Medicine Press
Citation
Hong Kong Medical Journal, 2023 How to Cite?
Abstract

Introduction: The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong.


Methods: We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann–Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV–predicted mortality.


Results: The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV–predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively).


Conclusions: As ECMO utilisation increased in Hong Kong, patients put on ECMO were older, more critically ill, and had more co-morbidities. It is important to combine service expansion with adequate resource allocation and training to maintain quality of care.


Persistent Identifierhttp://hdl.handle.net/10722/339249
ISSN
2023 Impact Factor: 3.1
2023 SCImago Journal Rankings: 0.261

 

DC FieldValueLanguage
dc.contributor.authorNg, Pauline Y-
dc.contributor.authorChan, Vindy WS-
dc.contributor.authorIp, April-
dc.contributor.authorLing, Lowell-
dc.contributor.authorChan, KM-
dc.contributor.authorLeung, Anne KH-
dc.contributor.authorChan, Kenny KC-
dc.contributor.authorSo, Dominic-
dc.contributor.authorShum, HP-
dc.contributor.authorNgai, CW-
dc.contributor.authorChan, WM-
dc.contributor.authorSin, WC-
dc.date.accessioned2024-03-11T10:35:08Z-
dc.date.available2024-03-11T10:35:08Z-
dc.date.issued2023-11-16-
dc.identifier.citationHong Kong Medical Journal, 2023-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/339249-
dc.description.abstract<p><strong>Introduction:</strong> The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong.</p><p><br></p><p><strong>Methods:</strong> We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann–Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV–predicted mortality.</p><p><br></p><p><strong>Results:</strong> The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV–predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively).</p><p><br></p><p><strong>Conclusions:</strong> As ECMO utilisation increased in Hong Kong, patients put on ECMO were older, more critically ill, and had more co-morbidities. It is important to combine service expansion with adequate resource allocation and training to maintain quality of care.</p>-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press-
dc.relation.ispartofHong Kong Medical Journal-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleTen-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong-
dc.typeArticle-
dc.identifier.doi10.12809/hkmj2210025-
dc.identifier.eissn2226-8707-
dc.identifier.issnl1024-2708-

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