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 0.12-1.03; 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, 19-25. 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. 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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), 1-46. doi:10.3310/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), 1374-1382. doi:10.1164/rccm.201311-2023OC [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), II103-10. doi:10.1097/01.MLR.0000068423.39715.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), 458-464. doi:10.1016/j.athoracsur.2015.03.092 [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