In-Hospital Outcomes, Complications, and Temporal Trends of Extracorporeal Membrane Oxygenation (ECMO) Use From 2016-2020: Results From the National Inpatient Sample

Document Type

Article

Abstract

PURPOSE: Extracorporeal membrane oxygenation (ECMO) has become increasingly utilized as life support for those with severe cardiac and/or pulmonary instability. This study assesses ECMO utilization with associated complications between the years of 2016 and 2020 using the National Inpatient Sample (NIS) database.

METHODS: The National Inpatient Sample datasets from 2016-2020 were queried to identify ECMO admissions using relevant ICD10 codes. Baseline characteristics including gender, LOS (length of stay), median total charge cost were obtained and associated in-hospital outcomes and complications were recorded. STATA, version 17.0 software (StataCorp LLC, College Station, TX) was used for the data analysis. All statistical analyses were performed on weighted data with results recorded as percentage for categorical variables.

RESULTS: Between 2016 and 2020, 51,995 ECMO cases were assessed with variables categorized on a yearly basis with higher prevalence among males (64.42% -vs- 35.58% in females). There was a temporal trend in increased ECMO use from 7,135 ECMO cases in 2016 to 14,550 ECMO cases in 2020 along with a decline in mortality from 2016 to 2020 (47.8% -vs- 42.6%, p<0.001). Throughout 2016-2020, >94% of ECMO cases were recorded at urban teaching hospitals. There was was an increase in LOS from 2016 to 2020 (23.9 days -vs- 27.6 days, p<0.001) and increase in total charge costs ($1,011,371 -vs- $766,241, p<0.001). There was an increase in bleeding requiring transfusions from 2016 to 2020 (18.4% -vs- 25.2%, p<0.001). An increase in continuous veno-venous hemodialysis (CVVHD) use was noted from 2016 to 2020 (16.1% -vs- 24.1%, p<0.004), an overall decline in use of intra-aortic balloon pump (18.0% -vs- 11.0%, p<0.001) and decline in destination left ventricular assist devices (LVAD) (5.1% -vs- 2.1%, p=0.002) with an increase in Impella devices (6.8% -vs- 10.9%, p=0.013).

CONCLUSIONS: With increased utilization of ECMO as a means of life support, it is important to note the risks and benefits given its usage of hospital resources. This data is reflective of increased usage of ECMO with almost doubling of ECMO cases from 2016 to 2020. Despite the increased usage of ECMO, there is a temporal trend of decreasing mortality rates during this timeline. Decreased mortality rates show promise into feasibility of ECMO use as a modality for mechanical circulatory support moving forward.

CLINICAL IMPLICATIONS: Better understanding of ECMO and its risks are crucial when considering the acutely critical nature of patients undergoing this intervention. The NIS study shows a temporal trend of increasing ECMO use across specialized academic centers in the US with an overall decreased trend in mortality rates.

First Page

A1811

DOI

10.1016/j.chest.2023.07.1249

Publication Date

10-2023

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