Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality improvement action (EQIA) study: a national cohort study in China from 2017 to 2019

Abstract

This cohort study was performed to explore the influence of intensive care unit (ICU) quality on in-hospital mortality of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO)-supported patients in China. The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019, using data from the National Clinical Improvement System and China National Critical Care Quality Control Center. ICU quality was assessed by quality control indicators and capacity parameters. Among the 2563 V-V ECMO-supported patients in 318 hospitals, a significant correlation was found between ECMO-related complications and prognosis. The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients (cutoff: 1.5% and 7.0%; 95% confidence interval: 1.05–1.48 and 1.04–1.45; odds ratios: 1.25 and 1.23; P = 0.012 and P = 0.015, respectively). Meanwhile, the V-V ECMO center volume was a protective factor (cutoff of ≥ 50 cases within the 3-year study period; 95% confidence interval: 0.57–0.83, odds ratio: 0.69, P = 0.0001). The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings. Thus, ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

Keywords

veno-venous extracorporeal membrane oxygenation / in-hospital mortality / high-volume centers / quality control / intensive care unit capacity parameters

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Acknowledgements

This study was funded by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS) from the CAMS (No. 2021-I2M-1-062); the National Key R&D Program of China, Ministry of Science and Technology of the People’s Republic of China (No. 2021YFC2500801); the Beijing Municipal Natural Science Foundation (No. M21019); the CAMS Endowment Fund (No. 2021-CAMS-JZ004); the China Medical Board Open Competition Program (No. 20-381); and the Chinese Medical Information and Big Data Association (CHMIA) Special Fund for Emergency Project.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-023-1014-x and is accessible for authorized users.

Compliance with ethics guidelines

Conflicts of interest Wei Cheng, Jieqing Chen, Xudong Ma, Jialu Sun, Sifa Gao, Ye Wang, Longxiang Su, Lu Wang, Wei Du, Huaiwu He, Yujie Chen, Zunzhu Li, Qi Li, Jianhua Sun, Hongbo Luo, Jinbang Liu, Guangliang Shan, Bing Du, Yanhong Guo, Dawei Liu, Chang Yin, and Xiang Zhou declare that they have no conflict of interest.

This article does not contain any studies involving human or animal subjects. The data collection was approved by the National Health Commission of China, and the study was approved by the institutional review board of Peking Union Medical College Hospital (approval number: SK1828). Because of the retrospective and deidentified nature of the data, a waiver for individual consent was granted by the research ethics board.

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