(277) An Analysis of the Racial Disparities in Outcomes in Patients With Cardiogenic Shock Requiring ECMO

Introduction: Extracorporeal membrane oxygenation (ECMO) has seen increased use in Critical Care medicine in those with refractory cardiogenic shock. Over the past 5 years, according to the Extracorporeal Life Support organization, only 48% of patients placed on ECMO for cardiac support survived. Our study aimed to investigate the demographic differences in outcomes for these patients.

Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify adults admitted with the ICD-10 diagnostic/procedural codes for Cardiogenic Shock and ECMO. Multivariate logistic regression analysis was used to obtain the odds ratios (OR) of inpatient mortality. Multivariate linear regression was used to determine the average length of hospital stay (LOS) and average total hospitalization charges (TOTCHG). Weighted analysis using Stata 17 MP was performed.

Results: A total of 4,589 adult patients were identified with Cardiogenic Shock that underwent ECMO in our analysis, of which 2,214 (48%) died.

We found that Asians/Pacific Islanders had a higher mortality rate (OR 1.51, p< 0.05, CI 1.09-2.10) when compared to White patients, assuming the same age, gender, and Charlson Comorbidity Index (CCI). There was no significant difference in mortality for all other minorities. Similarly, gender and primary insurance payer were not associated with a significant difference in mortality.

Similarly, Black (+6.80 days, p< 0.0001, CI 4.03-9.56) and Hispanic (+3.12 days, p< 0.05, CI 0.16-6.08) patients were found to have an increased average LOS. Total hospital charges were significantly higher in Blacks (+$134,563.40,p < 0.01,CI 59,890.39 - 209,236.40), Hispanics (+$239,541.40,p < 0.01, CI 115,740.00 - 363,342.80), and Asians/Pacific Islanders (+$281,515.00, p< 0.05, CI 43,809.44 - 519,220.60).

Conclusions: Asian/Pacific Islander ethnicity was associated with a significantly increased mortality rate and higher hospitalization costs when compared to White patients. Patients with Black or Hispanic ethnicity had a significantly longer LOS and increased TOTCHG compared to white patients. Further studies are warranted to investigate the underlying cause of these disparities to improve clinical outcomes in the future in these underserved populations.