Abstract:
Objective To investigate the development of extracorporeal membrane oxygenation (ECMO) technology, and provide reference for improving the ability and quality of ECMO application in Anhui Province.
Methods Using cross-sectional surveys, initiated by the ECMO Quality Control Center of Anhui Province, combined with the national technical application specifications and quality control indicators for ECMO, a survey questionnaire was designed. The survey content included the basic information of ECMO centers, current status of ECMO implementation, distribution of ECMO implementation by academic disciplines, qualifications of ECMO technical personnel, equipment of ECMO, management of ECMO technology and suggestions for the development of ECMO. The survey was conducted on the 26 hospitals that had purchased ECMO equipment in the province.
Results There were a total of 26 hospitals in the province that carried out ECMO technology, mainly tertiary and first-class hospitals (88.5%), and the number of Hefei (8, 30.8%) ranked the first in the province. Before 2019, the majority of ECMO centers in the province were located in university-affiliated hospitals (85.7%), while after 2019, the majority were located in non-university-affiliated hospitals (89.4%), which showed an overall upward trend year by year in the province. By the end of the survey, 1097 adult ECMO cases had been carried out in the province. The auxiliary survival rate was 49.4% (heart), 49.8% (respiratory), and 29.6% (ECPR), and the overall survival rate was 46.7%. The difference of the indications distribution (heart/respiratory/ECPR) of patients treated with ECMO technology was statistically significant between hospitals directly under the university and those no directly under the university (P < 0.01). There was no statistical significance in the survival rate of different ECMO indications between university hospitals and non-university hospitals (P > 0.05), but the total survival rate of university hospitals was higher than that of non-university hospitals (P < 0.01). In 2023, the total survival rate in hospitals with more than 20 cases was higher than that in hospitals with less than 20 cases (P < 0.05). In the province, the ECMO technology was mainly carried out in critical care medicine (92.3%) and emergency department (19.2%), and the ECMO equipment was mainly imported (96.2%). The personnel qualification of some hospitals (19.2%) did not meet the national management standards for clinical application of ECMO technology, and some hospitals (3.8% ~ 15.4%) did not have a sound ECMO technology management system. There were 19 hospitals (73.1%) that need to strengthen training and improve medical quality; It is suggested that 16 hospitals (61.5%) need to strengthen academic exchanges and share clinical experience. It is suggested that 15 hospitals (57.7%) need to provide technical guidance, expert sinking or remote consultation.
Conclusions In Anhui Province, ECMO technology has developed to a certain extent, but it is unbalanced in the distribution of regions, indications and disciplines, and the overall survival rate of ECMO in different nature and sizes hospitals is different. Meanwhile, the qualifications of ECMO personnel, technical management and training still need to be strengthened.