Cho Hyoung-Won, Song In-Ae, Oh Tak Kyu
Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Ann Transl Med. 2021 May;9(9):742. doi: 10.21037/atm-21-180.
Extracorporeal membrane oxygenation (ECMO) therapy requires close monitoring and optimal management after initiation. However, it remains unclear whether the day of the week of ECMO initiation affects patient outcomes. We aimed to investigate whether the initiation of ECMO therapy during a weekend was associated with increased mortality risk.
We performed a population-level cohort study, based on health records obtained from the National Health Insurance Service database in South Korea. All critically ill adult patients who received ECMO therapy in the intensive care unit during 2005-2018 were enrolled. The primary endpoint was the 60-day mortality rate following ECMO therapy. Multivariable Cox regression was used for the analysis.
Data from a total of 21,129 ECMO patients were included in the analysis, of whom 12,825 (60.7%) died within 60 days. There were 4,647 (22.0%) patients who received ECMO therapy during a weekend (weekend group). Multivariable Cox regression revealed that the weekend group was at increased risk of 60-day mortality compared to the weekday group (hazard ratio: 1.05, 95% confidence interval: 1.01 to 1.09; P=0.025). In the sensitivity analysis, ECMO patients whose therapy started on a Saturday were at higher risk of 60-day mortality (hazard ratio relative to those whose therapy started on a Wednesday: 1.11, 95% confidence interval: 1.04-1.19; P=0.003). However, starting ECMO therapy on other weekdays (Thursday, Friday, Sunday, Monday, or Tuesday) did not affect mortality outcomes (P>0.05).
ECMO therapy initiated during a weekend was associated with a slightly increased risk of 60-day mortality compared to that associated with ECMO therapy initiated on a weekday. This association was more evident in patients who received ECMO therapy that started on a Saturday. Further studies are needed to confirm these findings.
体外膜肺氧合（ECMO）治疗开始后需要密切监测和优化管理。然而，ECMO开始的星期几是否会影响患者预后仍不清楚。我们旨在调查在周末开始ECMO治疗是否与死亡风险增加相关。
我们基于从韩国国民健康保险服务数据库获得的健康记录进行了一项人群水平的队列研究。纳入了2005年至2018年期间在重症监护病房接受ECMO治疗的所有成年重症患者。主要终点是ECMO治疗后的60天死亡率。采用多变量Cox回归进行分析。
共有21129例ECMO患者的数据纳入分析，其中12825例（60.7%）在60天内死亡。有4647例（22.0%）患者在周末接受了ECMO治疗（周末组）。多变量Cox回归显示，与工作日组相比，周末组60天死亡风险增加（风险比：1.05，95%置信区间：1.01至1.09；P = 0.025）。在敏感性分析中，治疗于周六开始的ECMO患者60天死亡风险更高（相对于治疗于周三开始的患者的风险比：1.11，95%置信区间：1.04 - 1.19；P = 0.003）。然而，在其他工作日（周四、周五、周日、周一或周二）开始ECMO治疗不影响死亡率结局（P>0.05）。
与在工作日开始ECMO治疗相比，在周末开始ECMO治疗与60天死亡风险略有增加相关。这种关联在治疗于周六开始的患者中更为明显。需要进一步研究来证实这些发现。
