National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism

Department

Internal Medicine

Document Type

Article

Publication Title

Vascular Medicine (London, England)

Abstract

Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 ( p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE ( p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period ( p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.

First Page

230

Last Page

233

DOI

10.1177/1358863X18824650

Volume

24

Issue

3

Publication Date

6-1-2019

Medical Subject Headings

Adult; Clinical Decision-Making; Databases, Factual; Extracorporeal Membrane Oxygenation (adverse effects, mortality, trends); Female; Hospital Mortality (trends); Humans; Male; Middle Aged; Patient Selection; Pulmonary Embolism (diagnosis, mortality, therapy); Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States (epidemiology)

PubMed ID

30834824

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