Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study
Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients. Little is known about population-level short- and long-term outcomes following ECMO, including healthcare use and health system cost across a wide range of sectors.
Population-based cohort study in Ontario, Canada (October 1, 2009–March 31, 2017) of adult patients (≥ 18 years) receiving ECMO for cardiorespiratory support. We captured outcomes through linkage to health administrative databases. Primary outcome was mortality during hospitalization, as well as at 7 days, 30 days, 1 year, 2 years, and 5 years following ECMO initiation. We analyzed health system costs (in Canadian dollars) in the 1 year following the date of the index admission.
A total of 692 patients were included. Mean (standard deviation [SD]) age was 51.3 (16.0) years. Median (interquartile range [IQR]) time to ECMO initiation from date of admission was 2 (0–9) days. In-hospital mortality was 40.0%. Mortality at 1 year, 2 years, and 5 years was 45.1%, 49.0%, and 57.4%, respectively. Among survivors, 78.4% were discharged home, while 21.2% were discharged to continuing care. Median (IQR) total costs in the 1 year following admission among all patients were Canadian $130,157 (Canadian $58,645–Canadian $240,763), of which Canadian $91,192 (Canadian $38,507–Canadian $184,728) were attributed to inpatient care.
Hospital mortality among critically ill adults receiving ECMO for advanced cardiopulmonary support is relatively high, but does not markedly increase in the years following discharge. Survivors are more likely to be discharged home than to continuing care. Median costs are high, but largely reflect inpatient hospital costs, and not costs incurred following discharge.
KeywordsExtracorporeal membrane oxygenation ECMO Health services Acute respiratory distress syndrome Cardiogenic shock Cardiac arrest
SMF, PT, and KK conceived the study idea. SMF, DQ, PT, EF, LM, BR, and KK participated in study design. DQ and RT gathered the data and performed data analyses. All the authors interpreted the data analyses. All the authors co-wrote and revised the manuscript for intellectual content. All the authors provided their final approval for manuscript submission. All the authors agree to be accountable for all aspects of the work.
None received for this study. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
Compliance with ethical standards
Conflicts of interest
Dr. Eddy Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr. Fan reports receiving personal fees from ALung Technologies, Abbot, and MC3 Cardiopulmonary, outside of the submitted work. Dr. Daniel Brodie reports providing expert advice to Hemovent, Baxter, BREETHE, and ALung Technologies. Dr. Brodie reports receiving grants from ALung Technologies, receiving personal fees from Baxter, and anticipated personal fees from BREETHE, outside of the submitted work. None of the other authors report any conflict of interest.
The Ottawa Health Science Network Research Ethics Board.
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