1. Background & Hypothesis
ICU and Resource Utilization of VV-ECMO Patients and Equivalent Critically Ill Patients Bhasin V.1, Kashiouris M.G.2,3, Yajnik V.4, Czekajlo M.4, Debesa O. 2,3 1Virginia Commonwealth University School of Medicine, 2Department of Medicine, Division of Pulmonary & Critical Care Medicine, Virginia Commonwealth University 3Center for Adult Critical Care, Virginia Commonwealth University, 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 sought to examine the ICU and resource utilization of patients who underwent VV-ECMO compared to equivalent patients with the same admission APR-DRG (All Patient Refined Diagnostic Group), severity of illness and risk of death
Background & Hypothesis
109 patients enrolled; 23 patients (21%) underwent VV-ECMO
Baseline, Adjusted Hospital Charges for APR-DRG, tracheostomy or long-term mechanical ventilation with extensive procedures: $242,000
VV-ECMO: Additional $28,000 charges (95%, -$23,000 to -$28,000, P=0.8)
OSH Transfer in same APR-DRG: average additional charge of $325,000 (95%, $112,000 to $537,000, P=0.003)
VV-ECMO group had average of 4.2 additional ICU days (95% -3.6 to 12 days, P=0.3) and 5.2 additional hospital days (95% -6.1 to 16.5 days, P=0.36) compared to non-VV-ECMO group
Mortality: Average 0.35 OR of death in VV-ECMO group (95% CI 0.12 to 1.03, P=0.057).
Results
Table 1
Patients in the VV-ECMO group did not utilize more monetary and hospital resources, compared to equivalent APR-DRG patients calculated on admission
VV-ECMO group did not have an increased length of stay (ICU and Hospital Days)
VV-ECMO group demonstrated a trend towards improved survival
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
Moderate 15
Major 22
Extreme 54
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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,
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]
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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]
Roberts, T. E. (1998). Economic evaluation and randomised controlled trial of extracorporeal membrane oxygenation: UK collaborative trial. the extracorporeal membrane oxygenation economics working group. BMJ (Clinical Research Ed.), 317(7163), 911-5; discussion
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, adjusting for severity of illness, the risk of death, and outside hospital transfer status based on APR-DRG
Multinomial linear regressions to estimate the adjusted ICU and hospital length of stay, as well as the total hospital charges (in dollars), of patients with VV-ECMO, compared to patients without ECMO
Methods
Figure 1
Figure 2
Length of Stay (days)
Total Hospital Charges (USD)
No statistically significant difference in ICU or Hospital Length of Stay in VV-ECMO group vs. Control
Variation in Unadjusted Hospital Charges
 2011 Mayo Foundation for Medical Education and Research
Nothing to disclose