Abstract 16915: Extracorporeal Membrane Oxygenation for Pulmonary Embolism With Acute Right Ventricular Failure and Shock: National Trends of Use, Demographics and In-Patient Mortality in the United States 2011-2014

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is an emerging option for cardio-pulmonary support for patients with massive pulmonary emboli (PE) as a bridge to definitive treatments. Goal of this study is to assess the national trends of use, demographics and in-patient mortality of patients managed with ECMO for PE associated with acute right ventricular failure and shock. Methods: The National Inpatient Sample database was queried for patients above 18 years of age hospitalized between 2011-2014 with pulmonary emboli (ICD diagnoses codes 415.1, 415.11, 415.19). Patients with acute right ventricular failure and shock with hemodynamic instability were identified (ICD diagnoses codes 415.0, 785.59, 785.51, 785.50). Patients treated with ECMO were identified using the procedure code 39.65. SPSS version 24 was used for statistical analysis. Results: During the study period, there were 1,262,542 admissions with pulmonary emboli, out of which 32,978 had acute right ventricular failure and shock. ECMO was used in 450 patients and that showed an increasing trend over the years (figure 1), with an in-patient mortality rate of 59.2%. Mean length of stay was 23 days. More than 90% of these patients were managed in large urban teaching hospitals with bed-size more than 500. Around half (43%) of these were in the Southern US hospitals. Factors associated with higher mortality were male sex (68.8%), age >80 years (100%), Hispanic race (65%), lack of insurance (71.4%) and low socio-economic strata (income quartile 1st, 74.4%), p<0.05. Conclusion: Use of ECMO for cardio-pulmonary support in patients hospitalized for PE with acute right ventricular failure and shock is increasing over the years. Among these patients, male sex, age >80 years, Hispanic race, lack of insurance and lower socio-economic strata are associated with higher mortality.