Chiu Ryan, Pillado Eric, Sareh Sohail, De La Cruz Kim, Shemin Richard J, Benharash Peyman
UCLA Anderson School of Management, Los Angeles, California.
UCLA Division of Cardiac Surgery, Los Angeles, California.
J Card Surg. 2017 Mar;32(3):215-221. doi: 10.1111/jocs.13106. Epub 2017 Feb 8.
Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period.
A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes.
Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06).
In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO.
在过去十年中，体外机械支持（ECMO）在呼吸衰竭和心源性休克中的应用越来越广泛。有必要评估ECMO使用的临床和经济结果。本研究介绍了我们机构在9年期间使用静脉-动脉ECMO（VA-ECMO）的经验。
对我们机构的ECMO数据库进行回顾性分析，确定了2005年至2013年间接受VA-ECMO治疗的患者（N = 150）。根据适应症将患者分为四组：心脏术后综合征、需要心肺复苏（CPR）的心源性休克、不需要CPR的心源性休克以及呼吸衰竭。对行政记录中的医院费用进行了分析。采用趋势分析和相关性分析来评估临床和经济结果。
在符合纳入标准的150例患者中，28%因心脏术后综合征需要VA-ECMO，31.3%因需要CPR的心源性休克，35.3%因不需要CPR的心源性休克，5.4%因呼吸衰竭。ECMO的平均使用时间为5.0±3.4天，生存率为64%，四组之间无差异（p = 0.40）。ECMO相关费用平均每位患者为74,500±61,400美元，占医院总费用的6%。心源性休克患者的亚组分析显示，未接受CPR的患者ECMO相关费用增加了近两倍（p = 0.04），同时生存率有改善趋势（69.8%对51.1%，p = 0.06）。
鉴于ECMO患者在生存率和费用方面存在差异，进一步的研究应旨在确定能从早期启动ECMO中获益的患者群体。
