Chee Kiang Tay1, Yang Hyun Cho2, Jinkyeong Park3, Jeong Hoon Yang3, Chi Ryang Chung3, Kiick Sung4, Juhee Cho5, Danbee Kang6, Hyejeong Park7, Gee Young Suh8. 1. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. Electronic address: melvin.tay.c.k@sgh.com.sg. 2. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 4. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: kiick.sung@samsung.com. 5. Center for Clinical Epidemiology, Samsung Medical Centre, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 6. Center for Clinical Epidemiology, Samsung Medical Centre, Seoul, South Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. 7. Center for Clinical Epidemiology, Samsung Medical Centre, Seoul, South Korea. 8. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: suhgy@skku.edu.
Abstract
PURPOSE: ECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. MATERIALS AND METHODS: Retrospective analysis of data from the Korean Health Insurance Review and Assessment Service over 5 years, between August 1, 2009 and July 31, 2014. The ECMO group comprised patients who received ≥1 ECMO run. Data on patient demographics, ICU and hospital length of stay, cost, treatments, and in-hospital mortality were collected. Usage trends were analyzed by 5 one-year periods. RESULTS: Among 1, 265, 508 ICU patients, 6078 underwent ECMO during the study period. The number of ECMO patients rose by 2.5 times, and ECMO hospitals from 50 to 86 between periods 1 and 5. Compared to non-ECMO patients, the ECMO group was younger (59 years vs. 64 years, p < .0001) with more comorbidities. Healthcare expenditure and in-hospital mortality in the ECMO group were higher (US $23,600 vs. $5100; 63.4% vs. 12.6%; p < .0001). Using multivariable analysis, age ≥ 50 years, CRRT, and annual hospital ECMO volume < 20 negatively impacted survival to discharge. CONCLUSION: The prevalence of ECMO among ICU patients was 0.5%. The expenditure and in-hospital mortality of the ECMO group were four and five times higher than non-ECMO group respectively. An annual hospital ECMO volume ≥ 20 may improve survival to hospital discharge.
PURPOSE: ECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. MATERIALS AND METHODS: Retrospective analysis of data from the Korean Health Insurance Review and Assessment Service over 5 years, between August 1, 2009 and July 31, 2014. The ECMO group comprised patients who received ≥1 ECMO run. Data on patient demographics, ICU and hospital length of stay, cost, treatments, and in-hospital mortality were collected. Usage trends were analyzed by 5 one-year periods. RESULTS: Among 1, 265, 508 ICU patients, 6078 underwent ECMO during the study period. The number of ECMO patients rose by 2.5 times, and ECMO hospitals from 50 to 86 between periods 1 and 5. Compared to non-ECMO patients, the ECMO group was younger (59 years vs. 64 years, p < .0001) with more comorbidities. Healthcare expenditure and in-hospital mortality in the ECMO group were higher (US $23,600 vs. $5100; 63.4% vs. 12.6%; p < .0001). Using multivariable analysis, age ≥ 50 years, CRRT, and annual hospital ECMO volume < 20 negatively impacted survival to discharge. CONCLUSION: The prevalence of ECMO among ICU patients was 0.5%. The expenditure and in-hospital mortality of the ECMO group were four and five times higher than non-ECMO group respectively. An annual hospital ECMO volume ≥ 20 may improve survival to hospital discharge.