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Research Snapshot Theater: Sepsis/Shock, Adult II

(1483) Trends in Mortality Among Adult Patients With Septic Shock Undergoing ECMO: NIS Analysis 2016-2020

Tuesday, January 23, 2024
10:00 AM – 11:00 AM MT
Location: Connections Central - RST 04

    First Author(s)

  • Antony Arumairaj, MD

    Attending Physician
    New York City Health Hospitals Corporation
    Jersey City

    • Co-Author(s)

  • BN

    Bede Nriagu, MD

    Resident
    New York Medical College, Metropolitan Hospital Center, United States

  • TN

    Thomas Newman, MD

    Attending Physician
    New York Medical College, Metropolitan Hospital Center, United States

  • JM

    Joseph Mattana, MD

    Director, Department of Medicine
    New York Medical College, Metropolitan Hospital Center, United States

  • SC

    Shobhana Chaudhari, MD

    Program Director
    New York Medical College, Metropolitan Hospital Center, United States

  • NT

    Natoushka Trenard, MD

    Chief, Division of Pulmonary and Critical Care Medicine
    New York Medical College, Metropolitan Hospital Center, United States

Introduction: Extracorporeal membrane oxygenation (ECMO) is a highly effective salvage therapy for children with refractory septic shock. However, the outcome benefits of ECMO in adults with refractory septic shock remain controversial. This study aimed to determine the outcome of adult patients with septic shock who underwent ECMO from National Inpatient Sample (NIS) from 2016 to 2020.

Methods: We identified all hospitalizations among patients 18 years and above with a primary or secondary diagnosis of Septic Shock in the United States NIS database between 2016 to 2020. We examined the demographic differences in mortality among hospitalized patients with septic shock who utilized ECMO. Time to survival was also compared between patients hospitalized for septic shock with and without ECMO utilization using Kaplan-Meier survival estimates.

Results: Between 2016 to 2020, we identified 588,782 hospitalizations for septic shock, of which ECMO was used in 2926 patients (0.50%). The overall mortality rate among the study sample was 50.5% (1476 patients) and was higher among males than females (65.0% vs 35.0%). Survivors had a higher mean length of hospital stay than non-survivors (40.0 vs 25.7 days) with p< 0.0001. An increasing mortality trend was observed among hospitalized patients with septic shock who utilized ECMO from 2016 to 2020; 12.9%, 17.3%, 17.9%, 17.7%, and 34.2% for 2016, 2017, 2018, 2019, and 2020 respectively. We observed a higher proportion of non-survivors than survivors in 2016 (55% vs 45%), in 2017 (55% vs 45%) and in 2020 (51% vs 49%). This trend reversed in 2018 (48% vs 52%) and in 2019 (46% vs. 54%). The probability of survival among patients with septic shock who utilized ECMO were 0.5, 0.4, and 0.3 at a length of hospital stay of 30, 60, and 90 days, respectively, compared to 0.7, 0.55, and 0.5 among those with septic shock who did not utilize ECMO with p < 0.001. The adult patients with septic shock treated with ECMO had statistically significantly lower survival rates than those who did not use ECMO.

Conclusions: The survival rates among patients with septic shock treated with ECMO were statistically lower than those who did not utilize ECMO. The use of ECMO in adult patients with septic shock did not result in a statistically significant mortality benefit.