Kim Su Jin, Han Kap Su, Lee Eui Jung, Lee Si Jin, Lee Ji Sung, Lee Sung Woo
Department of Emergency Medicine, College of Medicine, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea.
Clinical Research Center, Asan Medical Center, 88 Olympic-ro 43-gil, songpa-gu, Seoul 05505, Korea.
J Clin Med. 2020 Nov 18;9(11):3703. doi: 10.3390/jcm9113703.
We attempted to determine the impact of extracorporeal membrane oxygenation (ECMO) on short-term and long-term outcomes and find potential resource utilization differences between the ECMO and non-ECMO groups, using the National Health Insurance Service database. We selected adult patients (≥20 years old) with non-traumatic cardiac arrest from 2007 to 2015. Data on age, sex, insurance status, hospital volume, residential area urbanization, and pre-existing diseases were extracted from the database. A total of 1.5% ( = 3859) of 253,806 patients were categorized into the ECMO group. The ECMO-supported patients were more likely to be younger, men, more covered by national health insurance, and showed, higher usage of tertiary level and large volume hospitals, and a lower rate of pre-existing comorbidities, compared to the non-ECMO group. After propensity score-matching demographic data, hospital factors, and pre-existing diseases, the odds ratio (ORs) of the ECMO group were 0.76 (confidence interval, (CI) 0.68-0.85) for 30-day mortality and 0.66 (CI 0.58-0.79) for 1-year mortality using logistic regression. The index hospitalization was longer, and the 30-day and 1-year hospital costs were greater in the matched ECMO group. Although ECMO support needed longer hospitalization days and higher hospital costs, the ECMO support reduced the risk of 30-day and 1-year mortality compared to the non-ECMO patients.
我们试图利用国民健康保险服务数据库，确定体外膜肺氧合（ECMO）对短期和长期预后的影响，并找出ECMO组和非ECMO组之间潜在的资源利用差异。我们选取了2007年至2015年非创伤性心脏骤停的成年患者（≥20岁）。从数据库中提取了年龄、性别、保险状况、医院规模、居住地区城市化程度和既往疾病等数据。253,806例患者中共有1.5%（n = 3859）被归入ECMO组。与非ECMO组相比，接受ECMO支持的患者更年轻、男性居多、享有国家医疗保险的比例更高，三级医院和大型医院的使用率更高，既往合并症发生率更低。在对人口统计学数据、医院因素和既往疾病进行倾向得分匹配后，使用逻辑回归分析得出，ECMO组30天死亡率的比值比（OR）为0.76（置信区间（CI）0.68 - 0.85），1年死亡率的OR为0.66（CI 0.58 - 0.79）。匹配后的ECMO组的首次住院时间更长，30天和1年的住院费用更高。尽管ECMO支持需要更长的住院天数和更高的住院费用，但与非ECMO患者相比，ECMO支持降低了30天和1年死亡率的风险。
