Muguruma Kohei, Kunisawa Susumu, Fushimi Kiyohide, Imanaka Yuichi
Department of Healthcare Economics and Quality Management Graduate School of Medicine Kyoto University Kyoto City Japan.
Department of Health Policy and Informatics Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan.
Acute Med Surg. 2020 Feb 12;7(1):e486. doi: 10.1002/ams2.486. eCollection 2020 Jan-Dec.
To describe the epidemiology of patients on extracorporeal membrane oxygenation (ECMO) and investigate the possible association between outcomes for respiratory ECMO patients and hospital volume of ECMO treatment for any indications.
Using data from the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database, between 1 July 2010 and 31 March 2018, we identified inpatients aged ≥18 years who underwent ECMO. Institutional case volume was defined as the mean annual number of ECMO cases; eligible patients were categorized into institutional case volume tertile groups. The primary outcome was in-hospital mortality. For ECMO patients with respiratory failure, the association between institutional case volume group and in-hospital mortality rate was analyzed using a multilevel logistic regression model including multiple imputation.
Extracorporeal membrane oxygenation was carried out on 25,384 patients during the study period; of those, 1,227 cases were for respiratory failure. Respiratory cases were categorized into low- (<8 cases/year), medium- (8-16 cases/year), and high-volume groups (≥17 cases/year). The overall in-hospital mortality rate for respiratory ECMO was 62.5% in low-, 54.7% in medium-, and 50.4% in high-volume institutions. With reference to low-volume institutions, the adjusted odds ratios (95% confidence interval) of the medium- and high-volume institutions for in-hospital mortality were 0.72 (0.50-1.04; = 0.082) and 0.65 (0.45-0.95; = 0.024), respectively.
The present study showed that accumulating the experience of using ECMO for any indications could positively affect the outcome of ECMO treatment for respiratory failure, which suggests the effectiveness of consolidating ECMO cases in high-volume centers in Japan.
描述接受体外膜肺氧合（ECMO）治疗患者的流行病学特征，并调查呼吸功能衰竭接受ECMO治疗患者的预后与任何适应症的ECMO治疗医院治疗量之间的可能关联。
利用日本全国住院患者诊断程序组合数据库在2010年7月1日至2018年3月31日期间的数据，我们确定了年龄≥18岁接受ECMO治疗的住院患者。机构病例量定义为ECMO病例的年均数量；符合条件的患者被分为机构病例量三分位数组。主要结局为住院死亡率。对于呼吸功能衰竭的ECMO患者，采用包括多重填补法的多水平逻辑回归模型分析机构病例量组与住院死亡率之间的关联。
在研究期间，共对25384例患者实施了体外膜肺氧合治疗；其中，1227例为呼吸功能衰竭患者。呼吸功能衰竭病例被分为低治疗量组（<8例/年）、中等治疗量组（8-16例/年）和高治疗量组（≥17例/年）。低治疗量机构中呼吸功能衰竭接受ECMO治疗患者的总体住院死亡率为62.5%，中等治疗量机构为54.7%，高治疗量机构为50.4%。以低治疗量机构为参照，中等治疗量和高治疗量机构住院死亡率的调整优势比（95%置信区间）分别为0.72（0.50-1.04；P=0.082）和0.65（0.45-0.95；P=0.024）。
本研究表明，积累任何适应症使用ECMO的经验可能对呼吸功能衰竭的ECMO治疗结果产生积极影响，这表明在日本将ECMO病例集中于高治疗量中心是有效的。
