ID:21 OA2-10 The Victorian ECMO Service: The impact of a statewide ECMO service on patient mortality outcomes

Background: In 2017, the Victorian Government commissioned Safer Care Victoria to evaluate extracorporeal membrane oxygenation (ECMO) practices across the state. This revealed a fragmented system with significant variation in practice and patient outcomes. Following extensive consultation, Safer Care Victoria developed a framework for the Victorian ECMO Service (VECMOS). In May 2020, VECMOS was introduced as a tiered, state-wide, 24/7 consultation and referral service, to streamline coordination, training and accreditation, and to standardize initiation criteria. The objective of this study was to compare the mortality of patients requiring ECMO in Victoria before and after the implementation of VECMOS. Methods: All patients who received ECMO were extracted from the ANZICS Adult Patient Database. Descriptive statistics and mixed-effects multivariable logistic regression were used to compare demographics and outcomes of all patients admitted to Victorian ICUs between January 2018 and May 2020 (pre-VECMOS) to patients admitted between June 2020 and December 2024 (VECMOS era). Results: A total of 307,684 ICU admissions to 48 ICUs were analysed, comprising 286,656 individual patient-episodes of whom 1,017 (0.35%) received ECMO (328 pre-VECMOS and 689 in the VECMOS era). Compared to those who received ECMO pre-VECMOS, patients in the VECMOS era were of similar age and sex, more commonly had respiratory diagnoses such as COVID-19, more commonly had a cardiac arrest, and more commonly underwent transfer between hospitals on ECMO. In-hospital mortality rate was 46.2% pre-VECMOS compared to 38.2% post-VECMOS (p=0.015). After adjusting for confounders, the VECMOS era was associated with a significant reduction in mortality for ECMO patients (adjusted odds ratio 0.72; 95% CI: 0.54-0.97; p=0.028). Conclusion: The introduction of a tiered networked statewide referral, coordination, education and retrieval service was associated with a reduction in mortality for patients who received ECMO in Victoria.