BACKGROUND: The aim of this study was to evaluate institutional volume-outcome relationships in extracorporeal membrane oxygenation (ECMO) with subanalyses of ECMO in patients with a primary diagnosis of respiratory failure. METHODS: All institutions with adult ECMO discharges in the Nationwide Inpatient Sample from 2002 to 2011 were evaluated. International Classification of Diseases (ninth revision) codes were used to identify ECMO-treated patients, indications, and concurrent procedures. Patients who were treated with ECMO after cardiotomy were excluded. Annual institutional and national volume of ECMO hospitalizations varied widely, hence the number of ECMO cases performed at an institution was calculated for each year independently. Institutions were grouped into high-, medium-, and low-volume terciles by year. Statistical analysis included hierarchical, multivariable logistic regression. RESULTS: The in-hospital mortality rates for ECMO admissions at low-, medium-, and high-volume ECMO centers were 48% (n = 467), 60% (n = 285), and 57% (n = 445), respectively (p = 0.001). In post hoc pairwise comparisons, patients in low-volume hospitals were more likely to survive to discharge compared with patients in medium-volume (p = 0.001) and high-volume (p = 0.005) hospitals. There was no significant difference in survival between medium-volume and high-volume hospitals (p = 0.81). In a subanalysis of patients with respiratory failure, low-volume ECMO centers maintained the lowest rates of in-hospital mortality (47%), versus 61% in medium-volume institutions (p = 0.045) and 56% in high-volume institutions (p = 0.15). Multivariable logistical regression produced similar results in the entire study sample and in patients with respiratory failure. CONCLUSIONS: ECMO outcomes in the Nationwide Inpatient Sample do not follow a traditional volume-outcome relationship, and these results suggest that, in properly selected patients, ECMO can be performed with acceptable results in U.S. centers that do not perform a high volume of ECMO.
BACKGROUND: The aim of this study was to evaluate institutional volume-outcome relationships in extracorporeal membrane oxygenation (ECMO) with subanalyses of ECMO in patients with a primary diagnosis of respiratory failure. METHODS: All institutions with adult ECMO discharges in the Nationwide Inpatient Sample from 2002 to 2011 were evaluated. International Classification of Diseases (ninth revision) codes were used to identify ECMO-treated patients, indications, and concurrent procedures. Patients who were treated with ECMO after cardiotomy were excluded. Annual institutional and national volume of ECMO hospitalizations varied widely, hence the number of ECMO cases performed at an institution was calculated for each year independently. Institutions were grouped into high-, medium-, and low-volume terciles by year. Statistical analysis included hierarchical, multivariable logistic regression. RESULTS: The in-hospital mortality rates for ECMO admissions at low-, medium-, and high-volume ECMO centers were 48% (n = 467), 60% (n = 285), and 57% (n = 445), respectively (p = 0.001). In post hoc pairwise comparisons, patients in low-volume hospitals were more likely to survive to discharge compared with patients in medium-volume (p = 0.001) and high-volume (p = 0.005) hospitals. There was no significant difference in survival between medium-volume and high-volume hospitals (p = 0.81). In a subanalysis of patients with respiratory failure, low-volume ECMO centers maintained the lowest rates of in-hospital mortality (47%), versus 61% in medium-volume institutions (p = 0.045) and 56% in high-volume institutions (p = 0.15). Multivariable logistical regression produced similar results in the entire study sample and in patients with respiratory failure. CONCLUSIONS: ECMO outcomes in the Nationwide Inpatient Sample do not follow a traditional volume-outcome relationship, and these results suggest that, in properly selected patients, ECMO can be performed with acceptable results in U.S. centers that do not perform a high volume of ECMO.
Authors: Brahmajee K Nallamothu; Hitinder S Gurm; Henry H Ting; Philip P Goodney; Mary A M Rogers; Jeptha P Curtis; Justin B Dimick; Eric R Bates; Harlan M Krumholz; John D Birkmeyer Journal: JAMA Date: 2011-09-28 Impact factor: 56.272
Authors: Cecillia Lui; Joshua C Grimm; J Trent Magruder; Samuel P Dungan; Joseph A Spinner; Nhue Do; Kristin L Nelson; Duke E Cameron; Luca A Vricella; Marshall L Jacobs Journal: Ann Thorac Surg Date: 2015-08-19 Impact factor: 4.330
Authors: Bryan G Maxwell; Andrew J Powers; Ahmad Y Sheikh; Peter H U Lee; Robert L Lobato; Jim K Wong Journal: J Thorac Cardiovasc Surg Date: 2013-11-01 Impact factor: 5.209
Authors: Tara Karamlou; Mina Vafaeezadeh; Andrea M Parrish; Gordon A Cohen; Karl F Welke; Lester Permut; D Michael McMullan Journal: J Thorac Cardiovasc Surg Date: 2012-12-14 Impact factor: 5.209
Authors: Alain Combes; Dan Brodie; Yih-Sharng Chen; Eddy Fan; José P S Henriques; Carol Hodgson; Philipp M Lepper; Pascal Leprince; Kunihiko Maekawa; Thomas Muller; Sebastian Nuding; Dagmar M Ouweneel; Antoine Roch; Matthieu Schmidt; Hiroo Takayama; Alain Vuylsteke; Karl Werdan; Laurent Papazian Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440
Authors: Frederik Seiler; Franziska C Trudzinski; Sabrina I Hörsch; Annegret Kamp; Carlos Metz; Monika Flaig; Mohammad Alqudrah; Holger Wehrfritz; Markus Kredel; Ralf M Muellenbach; Hendrik Haake; Robert Bals; Philipp M Lepper Journal: J Artif Organs Date: 2018-05-15 Impact factor: 1.731
Authors: Peter Moritz Becher; Alina Goßling; Benedikt Schrage; Raphael Twerenbold; Nina Fluschnik; Moritz Seiffert; Alexander M Bernhardt; Hermann Reichenspurner; Stefan Blankenberg; Dirk Westermann Journal: Crit Care Date: 2020-06-05 Impact factor: 9.097
Authors: J W Awori Hayanga; Jonathan Aboagye; Errol Bush; Joseph Canner; Heather K Hayanga; Alyssa Klingbeil; Paul McCarthy; James Fugett; Ghulam Abbas; Vinay Badhwar Journal: JTCVS Open Date: 2020-03-06
Authors: Mazen Odish; Cassia Yi; Christopher Tainter; Samira Najmaii; Julio Ovando; Laura Chechel; Jerry Lipinski; Alex Ignatyev; Alexander Pile; Yun Yeong Jang; Tuo Lin; Xin M Tu; Michael Madani; Mitul Patel; Angela Meier; Travis Pollema; Robert L Owens Journal: Crit Care Explor Date: 2021-06-15