1. Background & Hypothesis
Comparison of VV-ECMO and Non-ECMO Patient Mortality among Equivalent DRG Risk-Adjusted Patients Kashiouris M.G.1,2, Yajnik V.4, Bhasin V.1, Czekajlo M.4, Debesa O. 1,2 1Department of Medicine, Division of Pulmonary & Critical Care Medicine, Virginia Commonwealth University, 2Center for Adult Critical Care, Virginia Commonwealth University, 3Virginia Commonwealth University School of Medicine, 4Department of Anesthesiology, Virginia Commonwealth University
ECMO use in adults has increased significantly since 2007
ECMO is a cost-effective technology that can improve gas exchange and could improve survival in adults with severe respiratory failure
We hypothesized that the mortality of patients who underwent VV-ECMO is lower than the mortality of patients with the same admission APR-DRG (All Patient Refined Diagnostic Group), severity of illness, and risk of death who did not receive ECMO.
Background & Hypothesis
109 patients enrolled; 23 patients (21%) underwent VV-ECMO
Adjusted Mortality Odds Ratio (OR) = 0.35 (95% CI ; P=0.057) among VV-ECMO patients.
Adjusted Mortality of Outside Transfers:
VV-ECMO Group: 23% (95% CI 0-50%; P=0.03)
Control Group: 54% (95% CI 25-84%; P = 0.03)
Adjusted Mortality of Emergency Department Admissions:
VV-ECMO group: 55% (95% CI 25-84%; P=0.32)
Control Group: 71% (95% CI 56-85%; P=0.32)
Hosmer-Lemeshow Test: P=0.69, demonstrating good fit
Results
Table 1
VV-ECMO group experienced a trend towards lower adjusted mortality compared to patients in control group with same APR-DRG and equivalent severity of illness and risk of death.
VV-ECMO patients transferred from OSH demonstrated a statistically significant lower adjusted mortality compared to patients in control group with same APR-DRG and equivalent severity of illness and risk of death.
Conclusion
Baseline Demographics
VV-ECMO (n=23)
No VV-ECMO (n=86)
Total (n=109)
Admission Age, Years
Mean (SD)
54.1 (18.4)
37.7 (15.1)
50.6 (18.9)
Admission Source
Emergency Department 10 31 41
Clinic Referral 1 4 5
Transfer from OSH 12 51 63
Emergent Admission
Yes 14 56 70 No 9 30 39
Admit APR-DRG Severity of Illness
Moderate 15
Major 22
Extreme 54
PPT Scientific Poster_4x6 Blue Template.ppt
Baram, D., Daroowalla, F., Garcia, R., Zhang, G., Chen, J. J., Healy, E., et al. (2008). Use of the all patient refined-diagnosis related group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clinical Medicine.Circulatory, Respiratory and Pulmonary Medicine, 2,
Enger, T., Philipp, A., Videm, V., Lubnow, M., Wahba, A., Fischer, M., et al.(2014). Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: A prospective observational study. Critical Care (London, England), 18(2), R67. doi: /cc13824 [doi]
Fan, E., Gattinoni, L., Combes, A., Schmidt, M., Peek, G., Brodie, D., et al. (2016). Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts. Intensive Care Medicine, 42(5), doi: /s [doi]
Gerke, A. K., Tang, F., Cavanaugh, J. E., Doerschug, K. C., & Polgreen, P. M.(2015). Increased trend in extracorporeal membrane oxygenation use by adults in the united states since 2007. BMC Research Notes, 8, doi: /s [doi]
Papazian, L., Herridge, M., & Combes, A. (2016). Focus on veno-venous ECMO in adults with severe ARDS. Intensive Care Medicine, doi: /s [doi]
Peek, G. J., Elbourne, D., Mugford, M., Tiruvoipati, R., Wilson, A., Allen, E., et al. (2010). Randomised controlled trial and parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR). Health Technology Assessment (Winchester, England), 14(35), doi: /hta14350 [doi]
Schmidt, M., Bailey, M., Sheldrake, J., Hodgson, C., Aubron, C., Rycus, P. T., et al. (2014). Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score. American Journal of Respiratory and Critical Care Medicine, 189(11), doi: /rccm OC [doi]
Shen, Y. (2003). Applying the 3M all patient refined diagnosis related groups grouper to measure inpatient severity in the VA. Medical Care, 41(6 Suppl), II doi: /01.MLR CE [doi]
Tsai, H. C., Chang, C. H., Tsai, F. C., Fan, P. C., Juan, K. C., Lin, C. Y., et al. (2015). Acute respiratory distress syndrome with and without extracorporeal membrane oxygenation: A score matched study. The Annals of Thoracic Surgery, 100(2), doi: /j.athoracsur [doi]
References
Retrospective, case-control study (January 2012 – July 2016)
VCU Medical Center: 725-bed academic tertiary care hospital in Richmond, Virginia
Patients with severe respiratory failure and admission APR-DRG: Tracheostomy or long-term mechanical ventilation with extensive procedures
Patients with VV-ECMO compared to patients without VV- ECMO (control group), adjusting for severity of illness, the risk of death, and outside hospital transfer status based on APR-DRG
Multinomial linear regressions to estimate the risk of mortality among patients with VV-ECMO, compared to patients without ECMO
Hosmer–Lemeshow Test: to examine the calibration of the model and confirm goodness of fit.
Methods
Figure 1
Figure 2
 2011 Mayo Foundation for Medical Education and Research
Nothing to disclose