NATIONAL AND REGIONAL UTILIZATION OF EXTRACORPOREAL MEMBRANE OXYGENATION DURING THE COVID-19 PANDEMIC IN 2020: A NATIONAL INPATIENT SAMPLE SURVEY

SESSION TITLE: Advancements in ECMO SESSION TYPE: Original Investigations PRESENTED ON: 10/11/2023 07:15 am - 08:15 am PURPOSE: We aim to report the ECMO utilization patterns, patient characteristics, and outcomes during the COVID-19 pandemic. METHODS: We queried the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS) data for 2020 [2]. We included all adults (≥18-year-old) hospitalized with a diagnosis of COVID-19 using International Classification of Diseases, Tenth-Revision, Clinical Modification (ICD-10-CM) code U07.1 (sensitivity 98.01%; specificity 99.04%) and ECMO support was identified consistent with prior literature [3,4]. Statistical analyses were performed using Stata 16.0 (StataCorp. 2019). All reported P-values are 2-sided, with a value of <0.05 considered significant. RESULTS: Between January 1 and December 31, 2020, there were 1,677,740 adult COVID-19 hospitalizations. Of these cases, 208,595 required mechanical ventilation and 3,745 required ECMO support. National Outcomes and Trends Overall, the majority of EMCO use occurred in people aged 40-60 years (61.8%), with a significant male preponderance (68.6%), as well as high proportions of white (35.2%) and Hispanic patients (34.4%, Table 1). Hypertension, hyperlipidemia, and diabetes were the most common comorbidities. COVID-19 patients were predominantly hospitalized in urban (90.2%) teaching (71.5%) hospitals. Similarly, ECMO was predominantly utilized in urban (99.6%) teaching (94.7%) hospitals. In-hospital complications included sepsis (70.7%), acute kidney injury requiring renal replacement therapy (65.5%), and venous thromboembolism (27.5%). Regional Outcomes and Trends There was some regional variation in ECMO utilization and patient demographics across the four-regions (Northeast – 2.4/1,000 COVID-19-hospitalizations [95% confidence interval: 2.24-2.64], Midwest – 2.6 [2.43-2.81], South – 2.2 [2.10-2.34], West – 1.8 [1.65-1.96], p<0.001). The Midwest had the highest proportion of whites (41.7%) while the West had the highest proportion of Hispanic (58.8%) patients (Table 1). Hospital Utilization and Resources Overall, the 3,745 COVID-19-ECMO hospitalizations had a total cost of $908 million USD. Among COVID-19 hospitalizations with ECMO support, the mean hospital cost for survivors was $256,018 ±$13,245 (mean hospital length of stay; LOS 39 ±1.7 days) and non-survivors was $237,835 ± $13,084 (LOS 28 ±1.5 days). Among COVID-19 hospitalizations without ECMO support, the mean hospital cost for survivors was $17,933 ±$178 (LOS 7.45 ±0.03 days) and non-survivors was $41,626 ± $549 (LOS 11.43 ±0.08 days). CONCLUSIONS: To the best of our knowledge, this is the first population-based study to investigate ECMO utilization in the US during the 2020 COVID-19 pandemic. CLINICAL IMPLICATIONS: There are three major findings in our study. First, the cumulative incidence of 2.25 ECMO cases per 1,000 COVID-19-hospitalizations and 16.1 ECMO cases per 1,000 COVID-19 hospitalizations requiring mechanical ventilation. Secondly, the number of ECMO cannulations nationally was higher during the first pandemic wave (April-July, 37%) than the second wave (November-December, 14%), and these differences in utilization may be multifactorial. Thirdly, the total cost was $908 million for all COVID-19-ECMO hospitalizations in 2020. COVID-19-ECMO patients had a significantly higher hospital cost (p<0.001) and longer hospital length of stay (from admission to discharge, p<0.001) when compared to non-ECMO hospitalized COVID-19 patients irrespective of their ultimate survival. This highlights the importance of effectively risk stratifying patients being considered for ECMO to help identify the most appropriate candidates for ECMO cannulation. DISCLOSURES: No disclosure on file for Michael Eberlein No relevant relationships by Kam Sing Ho No relevant relationships by Andrea Levine No relevant relationships by Joseph Rabin No relevant relationships by Robert Reed