ICU capacity, ICU staffing, and postcardiotomy ECMO outcomes in China: a multilevel cross-sectional study

Qiu, Y; Ma, X; Li, Z; Cheng, W; Chen, Y; Fu, Y; Su, L; Ding, X; Wang, L; Chen, J; Pan, W; Jiang, H; Huang, Z; Li, Y; Shu, T; Zhou, X; China Critical Care Clinical Trials Group (CCCCTG); China National Critical Care Quality Control Center Group (China-NCCQC group)

doi:10.1186/s13054-025-05443-2

Intensive care unit (ICU) capacity, ICU staffing, and postcardiotomy ECMO outcomes in China: a multilevel cross-sectional study

Crit CarePublished 3 Jul 2025Cross-sectional study

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Authors' conclusion

While higher ICU capacity and staffing are associated with reduced mortality, they also correlate with longer hospital stays and/or increased costs

Study context

Population: Patients receiving postcardiotomy ECMO (PC-ECMO) in hospitals of China's National Quality Improvement Program, April 2016–December 2021
Participants: 2,601 patients · 102 hospitals

Exposure: Higher vs lower ICU capacity and ICU staffing ratios
Outcome: In-hospital mortality

Methodological detailsmultilevel, multicentre

Multilevel
Multicentre

Main finding

As reported in the abstract

Odds ratio (95% CI)P value

Higher ICUCCI

0.83(0.70–0.97)

P = 0.025

Ratio of patients per ICU bedmost pronounced effect among staffing ratios

0.69(0.55–0.87)

P = 0.002

Per ICU bed, as printed

Observational data: associations, not effects.

Secondary outcomes

Complications

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Higher ICUCCI	0.512	0.82 (0.68–0.99)	P = 0.046
	0.512Odds ratio (log scale)

Length of stay (LOS)

	← Lower risk ←→ Higher risk →	IRR (95% CI)	P value
Higher ICUCCI	0.512	1.14 (1.06–1.22)	P < 0.001
	0.512Incidence rate ratio (log scale)

Hospitalization costs

	← Lower risk ←→ Higher risk →	IRR (95% CI)	P value
Higher ICUCCI	0.512	1.32 (1.24–1.40)	P < 0.001
	0.512Incidence rate ratio (log scale)

Complications

Increased staffing did not affect overall complication rates

LOS

Increased staffing associated with longer LOS

Hospitalization costs

Increased staffing did not affect costs

Safety

Outcome	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Bloodstream infection	0.20.5125	1.96 (1.14–3.46)	P = 0.022
	0.20.5125Odds ratio (log scale)

Original publication

ICU capacity, ICU staffing, and postcardiotomy ECMO outcomes in China: a multilevel cross-sectional study. Crit Care. Published 3 July 2025. doi:10.1186/s13054-025-05443-2

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