Extracorporeal Membrane Oxygenation Use Has Increased by 433% in Adults in the United States from 2006 to 2011

Sauer, Christopher M.; Yuh, David D.; Bonde, Pramod

doi:10.1097/mat.0000000000000160

Cited by 283 publications

(188 citation statements)

References 15 publications

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“…Significant improvements in the ECMO circuit allowed for more aggressive ECMO use during the H1N1 influenza epidemic in 2009 (3). As a consequence, there has been sustained interest in adult ECMO, with an over 400% increase in U.S. cases from 2006 to 2011 (4,5).…”

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confidence: 99%

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

et al. 2016

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Rationale: The clinical ethics literature on extracorporeal membrane oxygenation (ECMO) has been focused primarily on identifying hypothetical ethical dilemmas that may arise with the use of this technology. Little has been written on the actual experience with ECMO-related ethical questions.Objectives: To describe the role of an ethics consultation service during the expansion of a single-center ECMO program in a cardiothoracic surgery intensive care unit (CSICU) and to identify common ethical themes surrounding the use of ECMO. Methods:We conducted a retrospective, descriptive cohort study of all ECMO ethics consultation cases in the CSICU at a large academic hospital between 2013 and 2015.Measurements and Main Results: During the study period, 113 patients were placed on ECMO in the CSICU, 45 (39.5%) of whom were seen by the ethics committee. In 2013, 10 of 46 (21.7%) patients received ethics consults. By 2015, 28 of 30 (93.3%) of patients were seen by ethics consultants. Initial consultation occurred at a median of 2 days (interquartile range, 1-6 d) following initiation of ECMO. The most common ethical issue involved disagreement about the ongoing use of ECMO, which included multiple axes: Disagreement among health care providers, disagreement among surrogates, and disagreement between health care providers and surrogates over stopping or continuing ECMO.Conclusions: In our experience with integrating ethics consultation into the routine care of ECMO patients, most of the ethical questions more closely resembled traditional concerns about the appropriate use of any life-sustaining treatment rather than the novel dilemmas imagined in the current literature.

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confidence: 99%

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

et al. 2016

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“…Less subject to debate, however, is the observation that patients who require ECMO likely have substantially increased healthcare costs relative to conventional management (4). Importantly, the number of hospitals offering ECMO has grown rapidly, particularly for adult patients (10,11), raising the concern that rapid diffusion of low-volume advanced care modalities across multiple institutions might compromise their efficiency and effectiveness (12,13).…”

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confidence: 99%

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Barbaro¹,

Odetola²,

Kidwell³

et al. 2015

Am J Respir Crit Care Med

592

400

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Rationale: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers.Objectives: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. Methods:We retrospectively analyzed an international registry of ECMO support from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to ,18 yr), and adult (>18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospitallevel variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013.Measurements and Main Results: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases.Conclusions: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013.

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“…These findings are particularly relevant as there has been a 433% increase in the number of adult patients supported with ECMO in the United States since 2006. 19 Interestingly, respondents from ACC reported to be more knowledgeable regarding ECMO compared with other specialties, suggesting that there is a gap in critical care training regarding ECMO exposure. A previous survey conducted among critical care physicians (in Australia and New Zealand) demonstrated lack of training and availability as a factor in limiting the ECMO use in ARDS.…”

Section: Discussionmentioning

confidence: 98%

Use of ECMO in the Management of Severe Acute Respiratory Distress Syndrome

et al. 2015

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Mortality of severe acute respiratory distress syndrome (ARDS) remains high. Once conventional mechanical ventilation fails, alternative modes of therapy are used; most of which have limited evidence to support their use. No definitive guidelines exist for the management of these patients with alternate modalities of treatment. We conducted a cross-sectional national survey of 302 adult critical care training programs in the United States to understand the current preferences of intensivists regarding the use of different therapies for severe ARDS, including the use of extracorporeal membrane oxygenation (ECMO). A total of 381 responses were received: 203 critical care faculty and 174 critical care trainees. Airway pressure release ventilation was the initial choice of treatment reported by most when conventional mechanical ventilation strategy failed followed by inhaled nitric oxide and prone positioning. Extracorporeal membrane oxygenation availability was reported by 80% of the respondents at their institutions. Most respondents (83%) would consider ECMO in patients who fail optimal mechanical ventilation strategies, and the majority (60%) believed that ECMO use can facilitate lung protective ventilation, but few favored its use as a first-line modality. The majority of respondents reported limited knowledge of ECMO and desired specific ECMO education during training.

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Extracorporeal Membrane Oxygenation Use Has Increased by 433% in Adults in the United States from 2006 to 2011

Cited by 283 publications

References 15 publications

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Analysis of the Extracorporeal Life Support Organization Registry

Use of ECMO in the Management of Severe Acute Respiratory Distress Syndrome

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