@shanf anfern ernands ands BACKGROUND Extracorporeal membrane - - PowerPoint PPT Presentation

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@shanf anfern ernands ands BACKGROUND Extracorporeal membrane - - PowerPoint PPT Presentation

Apr 04, 2023 442 likes •605 views

Shannon annon M. Fernando, nando, MD, , MSc 1, 1, ; ; Dania nial l Quresh eshi, i, MSc 2 ; ; Pet eter er Tanusep nuseputr utro, , MD, , MHS HSc 1,2,3 2,3 ; ; Edd ddy y Fan, n, MD, , Ph PhD 4 ; ; Laveena eena Munsh nshi, , MD,

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SLIDE 1

Shannon annon M. Fernando, nando, MD, , MSc1,

1,;

; Dania nial l Quresh eshi, i, MSc2; ; Pet eter er Tanusep nuseputr utro, , MD, , MHS HSc1,2,3

2,3;

; Edd ddy y Fan, n, MD, , Ph PhD4; ; Laveena eena Munsh nshi, , MD, , MSc4; ; Bra ram m Rochw chwerg erg, , MD, , MSc5; ; Rober ert t Tala larico rico, , MSc3; ; Damon mon C. Sca cales, les, MD, , PhD3,4

3,4;

; Daniel niel Brodie, die, MD6; ; Sonny y Dha hana nani, ni, MD1; ; Anne-Marie Marie Guerg rgueri uerian an, , MD, , PhD4; ; Sam D. Shemie mie, , MD7; ; Kednap dnapa Tha havor

  • rn,

, PhD1,2,3

2,3;

; and d Kwadw adwo

  • Kyerem

eremant anteng, eng, MD, , MHA HA1,2

,2

From the 1University of Ottawa, Ottawa, ON; 2Ottawa Hospital Research Institute, Ottawa, ON; 3ICES, Toronto, ON; 4University of Toronto, Toronto, ON; 5McMaster University, Hamilton, ON; 6Columbia University College of Physicians and Surgeons, New York, NY; 7McGill University, Montreal QC.

@shanf anfern ernands ands

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SLIDE 2

BACKGROUND

  • Extracorporeal membrane
  • xygenation (ECMO) is used for

temporary cardiorespiratory support in critically ill patients

  • A “bridge” to recovery or transplant
  • Little known regarding long-term
  • utcomes and costs associated with

ECMO

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SLIDE 3

STUDY OBJECTIVES

  • We conducted a population-based cohort study to evaluate

the short- and long-term health outcomes and costs of critically ill adults receiving ECMO for cardiorespiratory support

  • Utilize the ICES databases to conduct population-based

cohort analyses from Ontario, Canada (population of 13 million)

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SLIDE 4

STUDY METHODS

  • Inclusion Criteria:
  • Adult patients (≥ 18 years of age) receiving ECMO in Ontario between Oct. 1,

2009 and Mar. 31, 2017 (Cost data to Mar. 31, 2016)

  • Patients captured using ECMO Intervention Code from Discharge Abstract

Database AND OHIP billing code for ECMO (Z788)

  • Patients categorized as “Respiratory Failure”, “Cardiac Failure”, or “Other”, on

the basis of primary ICD-10 diagnosis

  • Outcomes:
  • Mortality (In-hospital, 7-day, 30-day, 1-year, 2-year, 5-year)
  • Long-term Costs (1st year following admission)
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SLIDE 5

Variab iable le Ove verall rall (n = 692 92) Respirat rator

  • ry Failure

lure (n = 321) Cardiac iac Failur lure (n = 303 03) Other (n = 72) 2) Mortalit ality follo lowing ing ECMO Initi tiati ation

  • n,

, n (%) In-Hospital 277 (40.0) 98 (30.5) 153 (50.5) 26 (38.2) 7-day 176 (25.4) 44 (13.7) 117 (38.6) 15 (22.1) 30-day 252 (36.4) 82 (25.5) 149 (49.2) 21 (30.9) 1-year 312 (45.1) 119 (37.1) 163 (53.8) 30 (44.1) 2-year 339 (49.0) 138 (43.0) 168 (55.4) 33 (48.5) 5-year 147 (57.4) 62 (53.4) 69 (62.2) 16 (55.2) Hospital tal Length gth of Stay, , days, , median an (IQR) 22 (9-45) 26 (15-54) 15 (5-35) 22 (9-45) Ventric ricular ular Assis ist Devic vice e During ing Hospitali talizati ation,

  • n, n (%)

92 (13.3) 15 (4.7) 75 (24.8) * Transplan lant During ing Hospitaliz talization ation, n (%) Heart Transplant 46 (6.6) 0 (0) 42 (13.9) 4 (5.6) Lung Transplant 193 (27.9) 173 (53.9) 13 (4.3) 7 (9.7) Transplant lant Patien ients ts Surviving viving to to Discharge, harge, n ( (%) Heart Transplant 30 (65.2) 0 (0) 28 (66.7) 2 (50.0) Lung Transplant 163 (84.5) 150 (92.0) 7 (53.8) 6 (85.7) Discha harge rge Dispos

  • sit

itio ion Among

  • ng Surviv

vivor

  • rs, n (%)

Home (without homecare) 174 (41.9) 106 (47.5) 60 (40.0) 8 (17.4) Home (with homecare) 153 (36.8) 72 (32.3) 61 (40.1) 20 (43.5) Long-term Care Facility 88 (21.2) 45 (20.2) 29 (19.3) 14 (30.4) Emergen gency Departm tmen ent Visit Follo lowing ing Dischar harge, ge, n (%) Within 30-days 82 (19.7) 43 (19.3) 26 (17.3) 13 (28.2) Within 90-days 157 (37.8) 90 (40.4) 48 (32.0) 19 (41.3) Within 1-year 270 (65.1) 153 (68.6) 91 (60.1) 26 (60.5) Hospital tal Readmis issions ions Follo lowing ing Discharge, harge, n (%) Within 30-days 67 (16.1) 41 (18.4) 19 (12.7) 7 (15.2) Within 90-days 125 (30.1 75 (33.6) 38 (25.3) 12 (26.1) Within 1-year 208 (50.1) 121 (54.3) 70 (46.7) 17 (37.0)

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SLIDE 6
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SLIDE 7

Mean n Cost sts s (SD) Medi dian an Cost sts s (IQR) R) Acut ute e Care e Sect ctor

  • rs

Inpatient (n = 550)

$137,339 ($145,203) $91,192 ($38,507-$184,728)

Emergency Department (n = 303)

$647 ($892) $421 ($0-$946)

Continu ntinuing ing Care e Sect ctor

  • rs

s Complex Continuing Care (n = 24)

$1,395 ($11,462) $0 ($0-$0)

Long-term Care (n = 2)

$21 ($454) $0 ($0-$0)

Rehabilitation (n = 105)

$4,518 ($14,462) $0 ($0-$0)

Home Care (n = 203)

$1,130 ($3,028) $0 ($0-$679)

Out utpati tient ent Care e Sectors Outpatient Clinics (n = 520)

$3,643 ($3,867) $2,321 ($731-$5,852)

Laboratory (OHIP) (n = 272)

$216 ($355) $0 ($0-$314)

Drugs (Ontario Drug Benefit Program) (n = 265)

$4,324 ($9,155) $0 ($0-$3,953)

Physician sician Billings ngs (n = 550) 0)

$25,401 ($17,447) $22,191 ($12,665-$33,656)

Tot

  • tal

al Costs ts

$18 181,2 ,248 8 ($170, 70,180) 0) $13 130,157 7 ($58, 8,645-$240,7 40,763) 63)

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SLIDE 8

CONCLUSIONS

  • In our population-based cohort, in-hospital mortality among critically

ill adult patients receiving ECMO was 40.0%, and incremental increase in 1-year, 2-year, or 5-year mortality was minimal

  • ECMO was frequently used as a bridge to transplant
  • The majority of ECMO patients who survived to hospital discharge

were discharged home

  • While ECMO patients accrued significant costs, the majority of these

costs were attributable to the ECMO admission, and not costs following discharge

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SLIDE 9

CONCLUSIONS

Fernando ndo et et al., ., Crit Care Med, 2018 18 Reardon don et et al., Crit Care e Res Pract ct, 2018 18

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SLIDE 10

LIMITATIONS

  • Highly selected population
  • Did not have data on ECMO configuration
  • Did not have data on complications of ECMO (hemorrhage,

thrombosis, infection)

  • The large majority of patients came from three major centres

(University Health Network, London Health Sciences Centre, University of Ottawa Heart Institute)

  • Limited by granularity of ICES data (e.g. no data on illness severity)
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SLIDE 11

Inten ensi sive e Care e Med. 2019. 45:158 580-1589. 89.

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SLIDE 12

ACKNOWLEDGEMENTS

  • Dr. Kwadwo Kyeremanteng
  • Dr. Peter Tanuseputro
  • Danial Qureshi and Robert Talarico
  • Drs. Eddy Fan, Laveena Munshi, Bram Rochwerg, Damon

Scales, Daniel Brodie, Sonny Dhanani, Anne-Marie Guerguerian, Sam Shemie, Kednapa Thavorn

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SLIDE 13

QUESTIONS/COMMENTS?

@sh shan anfer ernands nands

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SLIDE 14

Variab iable le Value ue Sex, n ( (%) Male 429 (62.0) Female 263 (38.0) Age, e, years, , mean n (SD) 51.3 (16.0) Incom

  • me,

e, n (%) Lowest 129 (18.6) Low 142 (20.5) Middle 139 (20.1) High 138 (19.9) Highest 142 (20.5) Unknown * Ruralit lity, , n (%) Urban 612 (88.4) Rural 80 (11.6) Indic icati ation

  • n for ECMO

Respiratory Failure 321 (46.4) Cardiac Failure 303 (43.8) Other 68 (9.8) Time e to to ECMO from Admis ission, ion, days, , median ian (IQR) 2 (0-9) Charls lson

  • n Comorbidit

rbidity Index, , n (%) ≤ 2 531 (76.7) 3-4 119 (17.2) ≥ 5 42 (6.1) Comorb rbidi iditi ties es, , n ( (%) Arrhythmia 113 (16.3) Malignancy 127 (18.4) Congestive Heart Failure 229 (33.1) Chronic Obstructive Pulmonary Disease 130 (18.8) Coronary Artery Disease 187 (27.0) Dementia * Diabetes Mellitus 197 (28.5) Hypertension 350 (50.6) Chronic Kidney Disease 116 (16.8) Cerebrovascular Disease 24 (3.5)

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SLIDE 15