The evolving use of ECMO: The impact of the CESAR trial.

INTRODUCTION: To compare characteristics and outcomes of patients receiving extracorporeal membrane oxygenation (ECMO) therapy as well as medical research activities related to ECMO before and after release of preliminary results of the CESAR trial.

METHODS: We assessed trends in EMCO use among adults, patient and institutional characteristics, in-hospital mortality, peri-procedural complications and resource use before and after first quarter of 2008 in Nationwide Inpatient Sample Database. Literature review was conducted to evaluate publications related to adult ECMO during the same time period.

RESULTS: Overall, 8389 patients received ECMO therapy between 2001 and 2011. ECMO use remained stable between 2001 and 2007 and increased significantly from 2008 to 2011. Comparing time periods before and after first quarter of 2008, patients on ECMO in later years were more likely to be older (Before vs. After: (age 65+) 18.9% vs. 23.1%) and have two or more comorbidities (43.6% vs. 52.3%). After adjusting for patient and institutional characteristics, in-hospital mortality was comparable for the two time periods (Odds Ratio 0.76, 95% CI 0.55-1.05). Between 2001 and 2011, 652 adult ECMO related English literature were identified, published in 181 English journals and by investigators from 31 countries. There was a significant increase in number of publications after 2008.

CONCLUSION: The presence of the CESAR trial was associated with significant increase in the utilization of ECMO in clinical practice and in the research activities related to ECMO. Moreover, ECMO has since been used in patients of older age and higher comorbidities, but with no increase in in-hospital mortality followed.