ABSTRACT
We report the ethnic and geographical distribution of patients undergoing extracorporeal membrane oxygenation (ECMO) at our institution in Honolulu, Hawaii. Some of the unique aspects of utilizing ECMO in the state of Hawaii include the complex geography of the Hawaiian islands separated by up to 400 km of ocean, as well as the transportation of patients from Hawaii to centers on the mainland that offer advanced cardiac therapies, the nearest which are 4000 km away. Patients who underwent venovenous (VV) and venoarterial (VA) ECMO cannulation from 2015-2022 were included in the analysis. Patient characteristics prior to cannulation and survival outcomes were analyzed. Ethnicity was compared to 2021 census data in the state of Hawaii. A total of 46 patients who underwent ECMO (VV =21 and VA = 25) were analyzed. The majority of ECMO patients were of Asian descent (50%), and 9% were of Native Hawai'ian descent. This reflects the ethnic diversity of Hawaii when compared to 2021 census data (37% Asian and 11% Native Hawai'ian). The most common indication for VA ECMO was cardiogenic shock due to advanced heart failure (26%) and for VV ECMO was COVID ARDS (22%). The majority of patients were from the island of Oahu (76%), and the remainder (26%) were from the other islands combined. In addition, 11% were transported to the mainland for advanced therapies on ECMO support. Survival to hospital discharge was 57% (48% for VA ECMO and 67% for VV ECMO). The patient characteristics of the ECMO program in our institution demonstrate the unique challenges and benefits of maintaining an ECMO program in Hawaii. Some potential solutions to mitigate these challenges include developing outreach programs for cardiac and critical care providers from the outer islands regarding the ECMO capabilities of our institution, consideration for mobile ECMO air units to cannulate patients directly in the outer islands, and the ability to offer end-stage therapies for cardiac and pulmonary failure on island. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
This article discussed Vietnam’s ongoing efforts to decentralize the health system and its fitness to respond to global health crises as presented through the Covid-19 pandemic. We used a general review and expert’s perspective to explore the topic. We found that the healthcare system in Vietnam continued to decentralize from a pyramid to a wheel model. This system shifts away from a stratified technical hierarchy of higher- and lower-level health units (pyramid model) to a system in which quality healthcare is equally expected among all health units (wheel model). This decentralization has delivered more quality healthcare facilities, greater freedom for patients to choose services at any level, a more competitive environment among hospitals to improve quality, and reductions in excess capacity burden at higher levels. It has also enabled the transformation from a patient-based traditional healthcare model into a patient-centered care system. However, this decentralization takes time and requires long-term political, financial commitment, and a working partnership among key stakeholders. This perspective provides Vietnam’s experience of the decentralization of the healthcare system that may be consider as a useful example for other countries to strategically think of and to shape their future system within their own socio-political context. Copyright © 2020 Via Medica