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Observational Study
. 2018 Jul 4;18(1):20.
doi: 10.1186/s12873-018-0171-8.

ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals

Rayan El Sibai  1 , Rana Bachir  1 , Mazen El Sayed  2   3
Affiliations
Observational Study

ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals

Rayan El Sibai et al. BMC Emerg Med. .

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals.

Methods: A retrospective observational study of the US Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified.

Results: A total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were $589,610.5. Mean length of stay was 21.8 days. Increased mortality was associated with presence of respiratory diseases (OR = 3.83), genitourinary diseases (OR = 4.97), undergoing an echocardiogram (OR = 4.63), and presenting during seasons other than Fall. Lower mortality was noted in patients with injury and poisoning (OR = 0.47), in those who underwent certain vascular procedures (OR = 0.49) and those with increasing length of stay (OR = 0.90).

Conclusion: Mortality in patients with cardiogenic shock remains high despite ECMO use. Season of admission (other than Fall) and presence of specific comorbidities (Respiratory and genitourinary diseases) are associated with increased mortality in this population. Familiarity with these variables can help identify patients at higher risk of death and can help improve outcomes further in cardiogenic shock.

Keywords: Critical illness; Emergency service, hospital; Extracorporeal circulation; Extracorporeal membrane oxygenation; Resuscitation; Shock, cardiogenic.

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Conflict of interest statement

Ethics approval and consent to participate

An exemption for the use of this de-identified dataset was obtained from the institutional review board (IRB) office at the American University of Beirut. This database is defined as limited data set under the HIPAA Privacy Rule and as such is de-identified prior to use and is waived from consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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