title: Survival Following Veno-Venous Extracorporeal Membrane Oxygenation and Mortality in a Diverse Patient Population.
abstract: Racial and ethnic disparities in cardiovascular disease are well established; however, there is limited information about survival differences following veno-venous extracorporeal membrane oxygenation (VV-ECMO) in contemporary adult populations. The purpose of this study was to assess survival at discharge, 30 days, and at 1 year following institution of VV-ECMO in an ethnically diverse population, and to examine potential risk factors for mortality. This was a single-center study of 41 patients (49% female, 27% minorities, 7% > 65 years) who received VV-ECMO between the years 2004 and 2013 at an academic medical center. Kaplan-Meier estimates were calculated to assess survival up to 1 year, and cox proportional hazard models were used to evaluate the association between risk factors, mortality, and confounders. Overall, 76% (n = 31) of VV-ECMO patients survived to discharge and 30 days and 71% (n = 29) survived to 1 year. Whites (n = 30) had a higher survival at 1 year compared to minorities (n = 11) (83% vs. 36%, respectively, p = .01). Minorities had a significantly increased risk of mortality at 30 days (hazard ratio [HR] = 5.07, 95% confidence interval [CI] = 1.42-18.09) and at 1 year (HR = 5.19, 95% CI = 1.63-16.55). Race/ethnicity remained a significant independent predictor of survival at 30 days except when history of shock or lung transplantation was included in adjusted regression models. VV-ECMO was associated with an excellent overall survival up to 1 year. Racial/ethnic minorities had a 5-fold increased risk for 30-day mortality, which was largely explained by a lower likelihood of lung transplantation and increased risk of shock.
authors.affiliation: University of Colorado Hospital, Aurora, Colorado.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Mosca
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: David L
authors.initials: DL
authors.lastname: Narotsky
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Ming
authors.initials: M
authors.lastname: Liao
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Heidi
authors.initials: H
authors.lastname: Mochari-Greenberger
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Beck
authors.affiliation: University of Colorado Hospital, Aurora, Colorado.
authors.forename: Linda
authors.initials: L
authors.lastname: Mongero
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: mortality; race/ethnicity; survival; veno-venous extracorporeal membrane oxygenation
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