Shao-Wei Chen1, Feng-Chun Tsai2, Yu-Sheng Lin3, Chih-Hsiang Chang4, Dong-Yi Chen5, An-Hsun Chou6, Tien-Hsing Chen7. 1. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. 2. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. 3. Department of Cardiology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi City, Taiwan. 4. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan. 5. Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan. 6. Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. 7. Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan. Electronic address: skyheart0826@gmail.com.
Abstract
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a widely used technique for treating postcardiotomy cardiogenic shock (PCS); however, no study has compared the long-term outcomes of patients who receive ECMO support for PCS with those of the general population post cardiac surgery. METHODS: A total of 1141 patients who received ECMO after cardiac surgery between 2000 and 2011 were identified by using the Taiwan National Health Insurance Research Database. For each patient, we matched 5 non-ECMO patients who had undergone cardiac surgery by using propensity scores calculated for age, sex, 12 comorbid diseases, Charlson score, hospital level, type of cardiac surgery, and year of index hospitalization. The outcomes included all-cause mortality, readmission for any cause, and medical expenditure. RESULTS: The incidence of ECMO use after cardiac surgery in Taiwan was 1.91%. The ECMO group had a significantly higher risk of in-hospital mortality than did the non-ECMO group (61.7% vs 6.8%, odds ratio 22.34, 95% confidence interval 19.06-26.18). The risks of all-cause mortality and first readmission for any cause were greater in the ECMO group than that in the control group (P < .001, P < .001) in the first year, whereas no difference was observed after the first year of follow-up (P = .209, P = .474). Similar results were observed regarding the medical expenditure of admission after index admission discharge. CONCLUSIONS: Patients receiving ECMO for PCS had similar outcomes to those of the non-ECMO group after the first year of follow-up despite significantly poor outcomes during the in-hospital course.
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a widely used technique for treating postcardiotomy cardiogenic shock (PCS); however, no study has compared the long-term outcomes of patients who receive ECMO support for PCS with those of the general population post cardiac surgery. METHODS: A total of 1141 patients who received ECMO after cardiac surgery between 2000 and 2011 were identified by using the Taiwan National Health Insurance Research Database. For each patient, we matched 5 non-ECMO patients who had undergone cardiac surgery by using propensity scores calculated for age, sex, 12 comorbid diseases, Charlson score, hospital level, type of cardiac surgery, and year of index hospitalization. The outcomes included all-cause mortality, readmission for any cause, and medical expenditure. RESULTS: The incidence of ECMO use after cardiac surgery in Taiwan was 1.91%. The ECMO group had a significantly higher risk of in-hospital mortality than did the non-ECMO group (61.7% vs 6.8%, odds ratio 22.34, 95% confidence interval 19.06-26.18). The risks of all-cause mortality and first readmission for any cause were greater in the ECMO group than that in the control group (P < .001, P < .001) in the first year, whereas no difference was observed after the first year of follow-up (P = .209, P = .474). Similar results were observed regarding the medical expenditure of admission after index admission discharge. CONCLUSIONS:Patients receiving ECMO for PCS had similar outcomes to those of the non-ECMO group after the first year of follow-up despite significantly poor outcomes during the in-hospital course.
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