Similarities in extracorporeal membrane oxygenation management across intensive care unit types in the United States: An analysis of the Extracorporeal Life Support Organization Registry

Abstract

Background Extracorporeal membrane oxygenation (ECMO) use in the United States occurs often in cardiothoracic ICUs (CTICU). It is unknown how it varies across ICU types. Methods We identified 10 893 ECMO runs from the Extracorporeal Life Support Organization (ELSO) Registry across 2018 and 2019. Primary outcome was ECMO case volume by ICU type (CTICU vs. non‐CTICU). Adjusting for pre‐ECMO characteristics and case mix, secondary outcomes were on‐ECMO physiologic variables by ICU location stratified by support type. Results CTICU ECMO occurred in 65.1% and 55.1% (2018 and 2019) of total runs. A minority of total runs related to cardiac surgery procedures (CTICU: 21.7% [2018], 18% [2019]; non‐CTICU: 11.2% [2018], 13% [2019]). After multivariate adjustment, non‐CTICU ECMO for cardiac support associated with lower 4‐ and 24‐h circuit flow (3.9 liters per minute [LPM] vs. 4.1 LPM, p < 0.0001; 4.1 LPM vs. 4.3 LPM, p < 0.0001); for respiratory support, lower on‐ECMO mean fraction of inspired oxygen ([FiO2], 67% vs. 69%, p = 0.02) and lower respiratory rate (14 vs. 15, p < 0.0001); and, for extracorporeal cardiopulmonary resuscitation (ECPR), lower ECMO flow rates at 24 h (3.5 LPM vs. 3.7 LPM, p = 0.01). Conclusions ECMO mostly remains in CTICUs though a minority is associated with cardiac surgery. Statistically significant but clinically minor differences in on‐ECMO metrics were observed across ICU types.

A qualitative analysis of physician decision making in the use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest

“…, 34. , 35. The constant need for more information is a fundamental tension that emerges from the physician’s narrative beginning with the initial decision making and continuing through to the resolution of each case.…”

Pulmonary Artery Pressures and Mortality During Venoarterial ECMO: An ELSO Registry Analysis

“…To further define our cohort of interest for subgroup analysis, we identified the presence or absence of concomitant mechanical circulatory support devices as well as cardiac surgery procedures based upon Current Procedural Terminology codes. As previously described, 32 postoperative cardiac surgery patients were identified using Current Procedural Terminology codes for heart or pericardium (33016–33999), excluding runs solely associated with codes for ECMO cannulation or daily management (33946–33989). Additionally, ventricular assist devices and LV unloading Current Procedural Terminology codes were identified, as described in Table S2.…”

Pulmonary Artery Pressures and Mortality during VA ECMO: An ELSO Registry Analysis

“…To further define our cohort of interest for subgroup analysis, we identified the presence or absence of concomitant mechanical circulatory support (MCS) devices as well as cardiac surgery procedures based upon Current Procedural Terminology (CPT) codes. As previously described, (31) postoperative cardiac surgery patients were identified using CPT codes for heart or pericardium (33016-33999) excluding runs solely associated with codes for ECMO cannulation or daily management (33946-33989). Additionally, ventricular assist devices (VADs) and LV unloading CPT codes were identified as described in Supplemental eTable 6.…”

“…Timing associated with MCS devices (i.e., LV unloading or intra-aortic balloon pumps) in relation to use specifically during concomitant ECMO run (rather than simply associated pre-cannulation or post-decannulation) was determined as previously described. (18,31) This retrospective analysis of the ELSO Registry was reviewed and approved by Weill Cornell Institutional Review Board.…”