National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism.
Ayman ElbadawiAmgad MentiasIslam Y ElgendyAhmed H MohamedMohammed Hz SyedGbolahan O OgunbayoOdunayo OlorunfemiIgor GosevSunil PrasadScott J CameronPublished in: Vascular medicine (London, England) (2019)
Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 ( p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE ( p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period ( p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- pulmonary embolism
- respiratory failure
- heart failure
- inferior vena cava
- mechanical ventilation
- healthcare
- insulin resistance
- metabolic syndrome
- intensive care unit
- radiation therapy
- physical activity
- cardiovascular events
- risk factors
- mental health
- weight loss
- quality improvement
- body mass index
- skeletal muscle
- single cell
- blood flow
- locally advanced
- cardiac resynchronization therapy
- medical students