Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Pramod Bonde

Second Advisor

John Geibel

Subject Area(s)

Surgery

Abstract

Objective:

Recent studies have shown the benefits of extracorporeal membrane oxygenation (ECMO) in supporting adults with severe respiratory or cardiac failure refractory to conventional treatments. The purpose of this investigation was to analyze the utilization of ECMO in adults to identify recent trends within the United States.

Methods:

In a serial cross-sectional study, the utilization rate of ECMO in adults in the United States from 2006 to 2011, as well as the survival rates and costs of hospitalization were analyzed using the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). The survival rates were further analyzed by grouping the hospitals by size, type, or volume of adult ECMO cases.

Results:

The rate of ECMO cases per million adult discharges increased 433% from 11.4 (95% CI, 6.1-16.8) in 2006 to 60.9 (95% CI, 28.1-93.7) in 2011 (p for trend = 0.001). Throughout this six-year period, there were no statistically significant changes in the survival rates (p for trend = 0.14), costs per day (p for trend = 0.07), or total costs per patient (p for trend = 0.87). Hospitals that were small, nonteaching, or had few adult ECMO cases were more likely to transfer their patients to other acute care hospitals.

Conclusion:

From 2006 to 2011, there was a huge increase in the utilization of ECMO in adults with no significant changes in survival rates or hospitalization costs. ECMO as a therapeutic modality should be given consideration in critically ill patients with reversible cardio-respiratory collapse.

Comments

This is an Open Access Thesis.

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