Impact of Extracorporeal Membrane Oxygenation on Mortality in Adults With Cardiac Arrest

Abstract

Previous studies regarding benefit of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest have yielded conflicting results. We aimed to determine whether ECMO in adults hospitalized with cardiac arrest is associated with improved survival compared with conventional cardiopulmonary resuscitation in a nationally representative sample. The U.S. Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (2006 to 2014) was utilized to identify a cohort of adults hospitalized with cardiac arrest at ECMO-capable facilities (defined by the presence of at least 1 ECMO procedure at the facility during the study period of 2006 to 2014). In-hospital mortality was compared between the ECMO and non-ECMO groups using generalized estimating equations with and without coarsened exact matching analysis. Of 273,690 hospitalizations for adults with cardiac arrest, 33,274 occurred at 363 ECMO-capable facilities, of which 775 (2.3%) involved the use of ECMO. There was no significant difference in in-hospital mortality between patients who received ECMO versus those who did not (60.1% vs 57.2%, p = 0.106). In the risk-adjusted analysis, the presence of ECMO was associated with higher rates of in-hospital mortality in the overall sample [odds ratio 1.59, 95% confidence interval 1.37 to 1.85] and the coarsened exact matching sample (n = 1,068 with 534 adults in each group; odds ratio 1.47, 95% confidence interval 1.14 to 1.88). In this cohort of hospitalizations for cardiac arrest at ECMO-capable centers in the U.S., adults who received ECMO had significantly higher mortality than those who did not receive ECMO. Large scale, adequately powered, randomized controlled trials are warranted to assess the benefit of ECMO in cardiac arrest.