ECMO for treatment of severe acute respiratory failure: adoption, effectiveness, and system-level implications

About This Grant

PROJECT SUMMARY/ABSTRACT Over 750,000 Americans experience acute respiratory failure in the United States each year. The mainstay of treatment for these patients is artificial respiratory support via conventional mechanical ventilation. Increasingly, the most severely ill of these patients are also treated with veno-venous extracorporeal membrane oxygenation (ECMO), an advanced form of life support which adds oxygen to the blood via an external circuit. Traditionally, ECMO was provided only to highly selected patients and only at high-volume hospitals. However, in recent years this pattern changed dramatically, with rapid increases in both the number of hospitals providing ECMO and the number of patients receiving ECMO. Despite the rapid adoption of ECMO, extremely little is known about the impact of these changes on patient outcomes and the health system as a whole. In this project we will directly address this knowledge gap by examining the comparative effectiveness and system-level effects of ECMO adoption. We will use a combination of all-payer utilization data and private payer claims data to obtain a comprehensive view of ECMO adoption, focusing on veno-venous ECMO for patients with severe acute respiratory failure. First, we will characterize ECMO adoption and identify the hospital and system-level factors driving the rapid uptake of ECMO in the United States. Second, we use state-of-the-art econometric modelling to determine the comparative effectiveness of ECMO relative to traditional mechanical ventilation alone, with additional analyses focused on identifying heterogeneity of treatment effects across patients and hospital types. Third, we will determine the potential unintended consequences of ECMO adoption, examining how intensive care unit case-mix and throughput change after hospitals launch ECMO programs. Together these studies will provide clinicians, hospital administrators and policy makers with much needed real-world data to guide future ECMO adoption and ensure that this costly and invasive technology is used for maximal benefit.