Huesch Marco D, Foy Andrew, Brehm Christoph
Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA.
HVICCU Adult ECMO Program, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA.
Crit Care Med. 2018 Jan;46(1):e87-e90. doi: 10.1097/CCM.0000000000002801.
To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade.
Retrospective analysis of administrative discharge data.
State-wide administrative discharge data from Pennsylvania between 2007 and 2015.
All 2,948 consecutive patients billed under a Diagnosis-Related Grouper 3 grouper and in whom a procedural code for extracorporeal membrane oxygenation was present, admitted between the beginning of 2007 and the end of 2015 to hospitals regulated by the state of Pennsylvania. Admitting diagnoses were coded as respiratory, cardiac, cardiac arrest, or uncategorized based on administrative data.
Unadjusted in-hospital mortality, length of stay, and discharge destination. Summary statistics and tests of differences by age 65 years or older and by admitting diagnosis were performed. Outcomes by age were plotted using running-mean smoothed graphs. Over the 9-year period, the average observed death rate was 51.7%. Among all survivors, 14.6% went home to self-care and a further 15.2% to home health care. Of all survivors, 43.8% were readmitted within 1 month, and 60.6% within 1 year. Among elderly survivors, readmission rates were 52.3% and 65.5% within 1 month and 1 year, respectively. The likelihood of dying in-hospital increased with age that of being discharged home or to postacute care decreased.
In a "usual clinical practice" setting, short-term outcomes are similar to those observed in clinical trials such as Conventional Ventilation or ECMO for Severe Adult Respiratory Failure, in registries such as extracorporeal life support organization, and in smaller single-site studies. More data on longer term follow-up are needed to allow clinicians to better inform patient selection and care.
研究近十年来一个州所有接受体外膜肺氧合治疗的成年患者的实际生存结果、住院时间和出院去向。
对行政出院数据进行回顾性分析。
2007年至2015年宾夕法尼亚州全州的行政出院数据。
2007年初至2015年底期间，宾夕法尼亚州监管的医院收治的所有2948例按诊断相关分组器3进行计费且有体外膜肺氧合程序代码的连续患者。根据行政数据，入院诊断分为呼吸、心脏、心脏骤停或未分类。
未调整的院内死亡率、住院时间和出院去向。按65岁及以上年龄和入院诊断进行汇总统计及差异检验。按年龄绘制的结果用移动平均平滑图表示。在9年期间，观察到的平均死亡率为51.7%。在所有幸存者中，14.6%回家自我护理，另有15.2%接受家庭医疗护理。在所有幸存者中，43.8%在1个月内再次入院，60.6%在1年内再次入院。在老年幸存者中，1个月和1年内的再次入院率分别为52.3%和65.5%。院内死亡的可能性随年龄增加，出院回家或接受急性后期护理的可能性降低。
在“常规临床实践”环境中，短期结果与在诸如《严重成人呼吸衰竭的传统通气或体外膜肺氧合》等临床试验、体外生命支持组织等登记处以及较小的单中心研究中观察到的结果相似。需要更多关于长期随访的数据，以便临床医生更好地为患者选择和护理提供信息。
