Trends in mortality and resource utilization for extracorporeal membrane oxygenation in the United States: 2008–2014

Abstract

Extracorporeal membrane oxygenation is used as a life-sustaining measure in patients with acute or end-stage cardiac or respiratory failure. We analyzed national trends in extracorporeal membrane oxygenation use and outcomes and assessed the influence of hospital demographics. Adult extracorporeal membrane oxygenation patients in the 2008-2014 National Inpatient Sample were evaluated. Patient and hospital characteristics, extracorporeal membrane oxygenation indication, mortality, and hospital costs were analyzed. A total 17,020 adult extracorporeal membrane oxygenation patients were considered: 47.4% respiratory failure, 38.6% postcardiotomy, 5.5% lung transplantation, 5.5% cardiogenic shock, and 3.2% heart transplantation. Admissions rose 361% from 1,026 in 2008 to 4,815 in 2014 (P < .0001), and the fraction of respiratory failure increased 40.5%-49.8% (P < .001). Elixhauser scores rose from 3.1 to 4.1 (P < .0001). Mortality decreased among total admissions from 62.4% to 42.7% (P < .0001) associated with an observed decline in postcardiotomy mortality. Mean hospital costs and length of stay remained stable throughout the study period. Although extracorporeal membrane oxygenation occurred most frequently at large hospitals, small and medium-sized hospitals showed significant expansion (P < .001). The Northeast exhibited a sustained three-fold per capita increase in extracorporeal membrane oxygenation rate (P < .0001). The past decade has seen an exponential growth of ECMO extracorporeal membrane oxygenation in the United States, with the fraction for respiratory failure displaying considerable growth. Overall extracorporeal membrane oxygenation patients experienced substantially reduced mortality, driven by improved outcomes for postcardiotomy patients, along with a trend toward an increased risk profile. Disproportionate use of extracorporeal membrane oxygenation in the Northeast warrants investigation of access to this technology across the United States.