title: Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012.
abstract: This study evaluates contemporary trends in the use and outcomes of adult patients undergoing extracorporeal membrane oxygenation (ECMO) in U.S. hospitals. All adult discharges in the Nationwide Inpatient Sample database during the years 2002-2012 that included ECMO were used to estimate the total number of U.S. ECMO hospitalizations (n = 12,407). Diagnostic codes were used to group patients by indication for ECMO use into postcardiotomy, heart transplant, lung transplant, cardiogenic shock, respiratory failure, and cardiopulmonary failure. A Mann-Kendall test was used to examine trends over time using standard statistical techniques for survey data. We found that ECMO use increased significantly from 2002-2012 (P = 0.003), whereas in-hospital mortality rate fluctuated without a significant difference in trend over time. No significant trend was observed in overall ECMO use from 2002-2007, but the use did demonstrate a statistically significant increase from 2007-2012 (P = 0.0028). The highest in-hospital mortality rates were found in the postcardiotomy (57.2%) and respiratory failure (59.2%) groups. Lung and heart transplant groups had the lowest in-hospital mortality rates (44.10% and 45.31%, respectively). The proportion of ECMO use for postcardiotomy decreased from 56.9% in 2002 to 37.9% in 2012 (P = 0.026) and increased for cardiopulmonary failure from 3.9% to 11.1% (P = 0.026). We concluded that ECMO use in the United States increased between 2002 and 2012, driven primarily by increase in national ECMO use beginning in 2007. Mortality rates remained high but stable during this time period. Though there were shifts in relative ECMO use among patient groups, absolute ECMO use increased for all indications over the study period.
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Fenton H
authors.initials: FH
authors.lastname: McCarthy
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McDermott
authors.affiliation: Division of Cardiovascular Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kini
authors.affiliation: Department of Anesthesia, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Gutsche
authors.affiliation: Division of Cardiovascular Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Joyce W
authors.initials: JW
authors.lastname: Wald
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Electronic address: Nimesh.Desai@uphs.upenn.edu.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
mesh_terms: D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States