ECMO therapy out of reach for multiple socioeconomic groups

Due to socioeconomic disparities, certain groups using ventilators were less likely to receive extracorporeal membrane oxygen therapy (ECMO) treatment years before the pandemic.

Women were relatively 27% less likely to receive ECMO than men (adjusted OR 0.73, 95% CI 0.70-0.75), and Medicaid patients were approximately more likely to receive more advanced treatment for severe respiratory failure. It was half. Those with private insurance (adjusted OR 0.55 95% CI 0.52-0.57) reported his Anuj Mehta, M.D., Ph.D., and colleagues at the University of Colorado School of Medicine, Denver.

Furthermore, individuals living in lowest-income areas were 37% less likely to be ECMO than those living in high-income areas (adjusted OR 0.63, 95% CI 0.60-0.67). Chronicles of the American Thoracic Society.

“We speculate that several factors contribute to the observed differences in ECMO utilization by gender, insurance, and neighborhood income in this study: reduced access, restricted transfer practices, and patient preferences. , is an implicit provider bias,” the group wrote.

Disparities persisted when cross-reactivity was considered in the study results. For example, female patients remained less likely to receive ECMO regardless of their income status.It is access to care that perpetuates most of the different disparities that exist, according to the researchers.

ECMO is an advanced, resource-intensive therapy that can simulate cardiac, pulmonary, or both function in critically ill patients. Utilization of ECMO steadily risingthere was a significant increase from 2007, when there were approximately 352 ECMO admissions in the United States, to 2012, when there were 2,715.

The use of ECMO has been prominent during the pandemic. “last resort” For patients requiring respiratory support. in one study Of approximately 60,000 COVID patients, 4,044 received ECMO treatment, with a mortality rate of 39%.

However, most hospitals are not yet ECMO ready, and only about half of patients requiring ventilators end up in hospitals with advanced life support equipment.

“ECMO-capable hospitals tend to be concentrated far from large cities and rural areas (less than 15 cases of ECMO in rural hospitals in this study), and safety nets with ECMO capabilities There are very few hospitals,” the researchers explained.

In the current study, an analysis using several state inpatient databases found that black patients were less likely to be treated with ECMO than white patients (adjusted OR 0.72, 95% CI 0.65 -0.79). Medicaid, people living in low-income areas, and patients identified as black were more likely to use safety-net hospitals. low and likely related to the availability of ECMO in certain types. In hospitals, in specific areas. ”

Mehta and colleagues say that addressing gaps in access to ECMO treatment will help us better understand these disparities.

“The goal is to get people thinking about where the divide is within critical care,” Mehta said. press release From the NIH that funded the research. “The next step is to think about how to explore these disparities, using better data and better sources that support our long-term goal of ensuring equitable care.”

The study was based on data from 2016 to 2019 from the Nationwide Readmissions Database, with treatments confirmed by claim code.

A total of 2,170,752 patients received mechanical ventilation in this study only, and 18,725 were treated with ECMO.

36% of patients undergoing ECMO were female compared to 64% of males. Women were also less likely to be ventilator-only, but to a lesser extent (45% vs. 55%).

In terms of ECMO group insurance type, most patients were privately insured (38%) or Medicare beneficiaries (37%), followed by Medicaid (18%), other or no insurance. (7%). In the ventilator-only group, most had Medicare (58%), followed by Medicaid and private insurance (17% each), and other or no insurance ( 8%).

People living in high-income areas made up 25.1% of the ECMO group compared with 17.3% of the mechanical ventilation only group.

The researchers found that ECMO patients were more likely to be younger than those who received mechanical ventilation alone (54 vs 63), had a higher chance of chronic heart failure (38% vs 27%), and had a higher chance of chronic lung disease. lower (19% vs. 32%).

Among the limitations of this study were the inability to further classify the ECMO population as ‘at-risk’, the inability to distinguish between hospital-assigned and self-identified racial demographics, and the inability to claim There is a potential error in code classification.