title: Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital.
abstract: BACKGROUND
  The role of extracorporeal membrane oxygenation (ECMO) for adults in regional centres with low numbers of patients receiving ECMO is unclear. A robust service delivery model may assist in the quality provision of ECMO.
  
  
  OBJECTIVE
  To describe a novel ECMO service delivery model in a regional Australian hospital, reporting on patient characteristics and outcomes before and after its implementation.
  
  
  METHODS
  An observational cohort study of all patients receiving ECMO at the University Hospital Geelong intensive care unit before and after implementation of a new ECMO clinical service model. The program included intensivist training in cannulation and care for ECMO patients, nurse accreditation in ECMO maintenance, and establishing a relationship with an ECMO centre caring for a high number of patients. Data included ECMO caseload, circuit configuration, complications, durations of therapy, and survival to ECMO weaning and ICU and hospital discharge.
  
  
  RESULTS
  During the 14-year period for which we collected data, 61 adults received ECMO: 21 (35%) before and 40 (65%) after implementation of the structured program. The median annual case rate increased significantly between periods from two (range, 0-5 cases) to 10 (range, 5-13 cases) (P < 0.01). Other changes from before to after implementation included more medical indications for ECMO (48% v 80%; P < 0.01), higher peripheral cannulation configuration (57% v 98%; P < 0.01) and greater intensivist involvement as cannulation proceduralists (29% v 80%; P < 0.01). There were no significant differences between cohorts in ECMO weaning or duration, complication rates or ICU or in-hospital mortality.
  
  
  CONCLUSIONS
  Provision of ECMO in a tertiary regional hospital within a multifaceted clinical service model is feasible and safe. Partnership with a centre providing ECMO for a high number of patients during service development and delivery is desirable.
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia. joseph.mccaffrey@barwonhealth.org.au.
authors.forename: Joe
authors.initials: J
authors.lastname: McCaffrey
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Orford
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Simpson
authors.affiliation: Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia.
authors.forename: Jill Lamb
authors.initials: JL
authors.lastname: Jenkins
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Geelong, Geelong, VIC, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Morley
authors.affiliation: Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Vin
authors.initials: V
authors.lastname: Pellegrino
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational