ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals

Abstract

BackgroundExtracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals.MethodsA retrospective observational study of the US Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified.ResultsA total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were $589,610.5. Mean length of stay was 21.8 days.Increased mortality was associated with presence of respiratory diseases (OR = 3.83), genitourinary diseases (OR = 4.97), undergoing an echocardiogram (OR = 4.63), and presenting during seasons other than Fall. Lower mortality was noted in patients with injury and poisoning (OR = 0.47), in those who underwent certain vascular procedures (OR = 0.49) and those with increasing length of stay (OR = 0.90).ConclusionMortality in patients with cardiogenic shock remains high despite ECMO use. Season of admission (other than Fall) and presence of specific comorbidities (Respiratory and genitourinary diseases) are associated with increased mortality in this population. Familiarity with these variables can help identify patients at higher risk of death and can help improve outcomes further in cardiogenic shock.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0171-8) contains supplementary material, which is available to authorized users.

Cross-sectional study for the clinical application of extracorporeal membrane oxygenation in Mainland China, 2018

“…These measures aim to markedly improve the level of ECMO development and the patient survival rate in Mainland China. Our data showed that the average length of hospital days on ECMO was 17 days, which is similar to that of other countries [1]. We also found that the hospital stay was significantly different between VA and VV ECMO.…”

“…These data from 1700 tertiary hospitals might not include all 2018 instances of ECMO in the Mainland, as of all the 2451 tertiary hospitals that were in operation in 2018, the rest hospitals might have also performed this technique in addition to these ones, although to a much lesser extent. In a non-SARS-CoV-2 world, a reasonable figure for ECMO incidence would be 0.3-0.5/100,000 if the resources are used wisely [1,[7][8][9][10][11] . China still has a large gap compared with this figure.…”

“…A recent study showed that the average cost for patients receiving ECMO in the ICU in the US was $73,122 for the placement procedures, with a total hospital cost of $210,100 [12]. Unlike in many countries [1], medical insurance in China does not fully cover the costs of ECMO treatment, and patients themselves must pay a large part of the costs. Although China's GDP per capita reached $9936 in 2018, it was only $1594 in remote areas with low socioeconomic levels.…”

“…ECMO has been widely used to treat various types of acute cardiogenic shock and respiratory failure among adults in whom conventional life support has failed. In recent years, an increasing number of patients with severe conditions have benefited from ECMO [1,2]. Extracorporeal life support technology has developed rapidly worldwide.…”

Extracorporeal Membrane Oxygenation in Cardiogenic Shock due to Acute Myocardial Infarction: A Systematic Review

“…Venoarterial ECMO provides the benefit of maintaining an optimal cardiac output, before or after coronary revascularization, enabling the use of lower doses of vasoactive drugs. In some studies, it was associated with high survival rates (up to 51% survival to discharge) in cardiogenic shock, being used as rescue therapy in these patients [9], with short-and long-term survival benefits of cardiopulmonary resuscitation compared to standard care [10].…”