Outcomes in cardiogenic shock patients with extracorporeal membrane oxygenation use: A matched cohort study in hospitals across the United States

Abstract

Background. ECMO is increasingly used for patients with critical illnesses. This study examines ECMO use in patients with cardiogenic shock in US hospitals and associated outcomes (mortality, hospital length of stay, and total hospital charges). Methods. A matched cohort retrospective study was conducted using the 2013 Nationwide Emergency Department Sample. Cardiogenic shock visits were matched (1: 1) and compared based on ECMO use. Results. Patients with ECMO (N=802) were compared to patients without ECMO (N=805). Mortality was higher in the ECMO group (48.9% versus 4.0%, p < 0.001). Visits with ECMO use also had higher average hospital charges ($580,065.8 versus $156,436.5, p < 0.001) and average hospital LOS (21.3 versus 11.6 days, p < 0.001). After adjusting for confounders, mortality (OR = 8.52 (95% CI: 2.84-25.58)) and charges (OR = 1.03 (95% CI: 1.02-1.05)) remained higher in the ECMO group, while LOS was similar (OR = 1.01 (95% CI: 0.99-1.02)). Conclusions. Patients with cardiogenic shock who underwent ECMO had increased mortality and higher cost of care without significant increase in LOS when compared to patients with cardiogenic shock without ECMO use. Prospective evaluation of this observed association is needed to improve outcomes and resources' utilization further. © 2018 Rayan El Sibai et al.