SESSION TITLE: Ventilatory Strategies in Severe Hypoxemia
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM
PURPOSE: The purpose of this study was to determine whether the use of extracorporeal membrane oxygenation (ECMO) has increased over the past decade in the United States and to determine if the rate of use changed at any point during this time. We also investigated mortality, length of stay, and demographics of patients who were treated with ECMO.
METHODS: We identified all hospitalizations from 2000 to 2010 in the Nationwide Inpatient Sample database during which ECMO use was recorded (ICD-9-CM 39.65). We aggregated cases semiannually to produce a national sample over time. We used a segmented linear regression model to determine the trend in ECMO use over time, and also to identify a temporal change point when the rate of ECMO use increased. To determine shifts in the demographics and characteristics of patients treated with ECMO, the total sample was then divided into two groups based on the identified change point. For binary outcomes (gender and mortality), comparisons of proportions were conducted using Pearson chi-square tests. For continuous outcomes (length of stay and age), comparisons of means were conducted using Wilcoxon rank sum tests.
RESULTS: ECMO use was gradually growing until the first half of 2007, at which time there was a drastic increase in the rate (p=0.0003). There was no difference in mortality before and after 2007 (66% versus 64%, p=0.34). Length of stay was longer after 2007 (19.9 versus 22.6 days, p=0.0001), and the percentage of women undergoing ECMO decreased after 2007 (43% vs. 36%, p=0.005). The mean age was approximately 50 years old before and after 2007 (p=0.89).
CONCLUSIONS: Despite controversy over the exact indications for ECMO, there has been a marked increase in use of ECMO since 2007.
CLINICAL IMPLICATIONS: As this procedure becomes more common, further study regarding indications, cost-effectiveness, and outcomes is warranted to guide optimal use of ECMO.
DISCLOSURE: The following authors have nothing to disclose: Alicia Gerke, Fan Tang, Joseph Cavanaugh, Kevin Doerschug, Philip Polgreen
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