Shannon M Fernando1,2, Danial Qureshi3,4,5, Peter Tanuseputro3,4,6,7,5, Eddy Fan8,9, Laveena Munshi8,10, Bram Rochwerg11,12, Robert Talarico4, Damon C Scales3,8,13,14, Daniel Brodie15, Sonny Dhanani16,17, Anne-Marie Guerguerian8,18, Sam D Shemie19,20, Kednapa Thavorn3,4,6, Kwadwo Kyeremanteng21,4,7,22. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 3. ICES, Toronto, ON, Canada. 4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 5. Bruyere Research Institute, Ottawa, ON, Canada. 6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 7. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 8. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. 9. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 10. Department of Medicine, Sinai Health System, Toronto, ON, Canada. 11. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 12. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 13. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 14. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 15. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, USA. 16. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. 17. Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 18. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 19. Department of Pediatrics, McGill University, Montreal, QC, Canada. 20. Division of Critical Care, Montreal Children's Hospital, Montreal, QC, Canada. 21. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 22. Institut du Savoir Montfort, Ottawa, ON, Canada.
Abstract
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients. Little is known about population-level short- and long-term outcomes following ECMO, including healthcare use and health system cost across a wide range of sectors. METHODS: Population-based cohort study in Ontario, Canada (October 1, 2009-March 31, 2017) of adult patients (≥ 18 years) receiving ECMO for cardiorespiratory support. We captured outcomes through linkage to health administrative databases. Primary outcome was mortality during hospitalization, as well as at 7 days, 30 days, 1 year, 2 years, and 5 years following ECMO initiation. We analyzed health system costs (in Canadian dollars) in the 1 year following the date of the index admission. RESULTS: A total of 692 patients were included. Mean (standard deviation [SD]) age was 51.3 (16.0) years. Median (interquartile range [IQR]) time to ECMO initiation from date of admission was 2 (0-9) days. In-hospital mortality was 40.0%. Mortality at 1 year, 2 years, and 5 years was 45.1%, 49.0%, and 57.4%, respectively. Among survivors, 78.4% were discharged home, while 21.2% were discharged to continuing care. Median (IQR) total costs in the 1 year following admission among all patients were Canadian $130,157 (Canadian $58,645-Canadian $240,763), of which Canadian $91,192 (Canadian $38,507-Canadian $184,728) were attributed to inpatient care. CONCLUSIONS: Hospital mortality among critically ill adults receiving ECMO for advanced cardiopulmonary support is relatively high, but does not markedly increase in the years following discharge. Survivors are more likely to be discharged home than to continuing care. Median costs are high, but largely reflect inpatient hospital costs, and not costs incurred following discharge.
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients. Little is known about population-level short- and long-term outcomes following ECMO, including healthcare use and health system cost across a wide range of sectors. METHODS: Population-based cohort study in Ontario, Canada (October 1, 2009-March 31, 2017) of adult patients (≥ 18 years) receiving ECMO for cardiorespiratory support. We captured outcomes through linkage to health administrative databases. Primary outcome was mortality during hospitalization, as well as at 7 days, 30 days, 1 year, 2 years, and 5 years following ECMO initiation. We analyzed health system costs (in Canadian dollars) in the 1 year following the date of the index admission. RESULTS: A total of 692 patients were included. Mean (standard deviation [SD]) age was 51.3 (16.0) years. Median (interquartile range [IQR]) time to ECMO initiation from date of admission was 2 (0-9) days. In-hospital mortality was 40.0%. Mortality at 1 year, 2 years, and 5 years was 45.1%, 49.0%, and 57.4%, respectively. Among survivors, 78.4% were discharged home, while 21.2% were discharged to continuing care. Median (IQR) total costs in the 1 year following admission among all patients were Canadian $130,157 (Canadian $58,645-Canadian $240,763), of which Canadian $91,192 (Canadian $38,507-Canadian $184,728) were attributed to inpatient care. CONCLUSIONS: Hospital mortality among critically ill adults receiving ECMO for advanced cardiopulmonary support is relatively high, but does not markedly increase in the years following discharge. Survivors are more likely to be discharged home than to continuing care. Median costs are high, but largely reflect inpatient hospital costs, and not costs incurred following discharge.
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