A System-wide ECMO Quality Collaborative Improves Patient Outcomes

Abstract Objective Extracorporeal membrane oxygenation (ECMO) use in adult patient populations has grown rapidly with wide variation in practices and outcomes. We evaluated the impact on patient outcomes, resource utilization, and costs of an initiative to coordinate and standardize best practices across ECMO programs within a large integrated healthcare system. Methods The ECMO Collaborative Project brought clinicians and service-line leaders from four programs within a single healthcare system together with operational subject matter experts tasked with developing and implementing standardized guidelines, order sets, and an internal database to support an automated quarterly report card. Patient outcomes, resource utilization, and financial measures were compared for the 16 months before (1/2017-4/2018; "Pre-Collaborative", n=185) vs the 14 months after (11/2018-12/2019, "Post-Collaborative", n=243) a 6-month implementation and blanking period. Subset analyses were performed for venoarterial ECMO (VA-ECMO), venovenous ECMO (VV-ECMO), and extracorporeal cardiopulmonary resuscitation (ECPR). Results Survival to discharge/transfer increased significantly (in-hospital mortality HR [95% CI], 0.75 [0.58, 0.99]) for the Post-Collaborative vs. the Pre-Collaborative period (107/185, 57.8% vs 113/243, 46.5%, p=0.03), predominantly due to improvement among VA-ECMO patients (HR [95% CI] 0.61 [0.41, 0.91]). The percentage of patients successfully weaned from ECMO increased from 58.9% (109/185) to 70% (170/243), p=0.02. Complication rates decreased by 40% (incidence rate ratio [95% CI], 0.60 [0.49, 0.72]).No significant changes were observed in ECMO duration, ICU or hospital length of stay, or cost-per-case; payment-per-case and contribution-margin-per-case both decreased significantly. Conclusions The ECMO Collaborative Project improved survival to discharge/transfer, weaning rates and complications, without additional costs, through coordination and standardization across ECMO programs within a healthcare system.