Disparities exist in patient selection for ECMO, study finds

In a study that included health insurance data from more than 2 million adults with serious respiratory illnesses, researchers found that women, people on Medicaid and people living in low-income neighborhoods were less likely receive extracorporeal membrane oxygenation (ECMO).

The results of the retrospective cohort study based on the American population were published in the Annals of the American Thoracic Society.¹

ECMO is an advanced form of life support for adults with severe respiratory conditions that simulates the function of the heart or lungs, giving the organs time to rest. Although advanced forms of therapies are known to have disparities, little was known if these disparities existed in the treatment of patients with ECMO.

“The goal is to really get people thinking about where certain disparities within critical care might live,” Anuj B. Mehta, MD, first author of the study and assistant professor of medicine at the Division of Pulmonary Sciences and Critical Care Medicine at Denver Health and Hospital Authority and the University of Colorado School of Medicine, said in a report.² “The next step is to think about how we can investigate these disparities with better data and better sources, which supports the long-term goal of ensuring equitable care.”

The data assessed in this study came from the National Readmissions Database from 2016 to 2019. Using billing codes, researchers were able to identify patients who received mechanical ventilation (MV) and/or ECMO.

Finally, researchers compared gender, insurance, and income levels of patients treated with MV with patients treated with ECMO and determined the adjusted odds ratio (AOR) of receiving ECMO based on patient contextual factors.

More than 2 million hospitalizations involving CF were identified in the data, and ECMO was used in 18,725 cases. Of ECMO-treated patients, 36.1% were female (AOR, 0.73; 95% CI, 0.70-0.75) and of MV-treated patients, only 44.5% were female .

Of the total number of patients treated with ECMO, 38.1% had private insurance, compared to 17.4% of patients with private insurance who received only MV. Additionally, patients with Medicaid insurance were less likely to receive ECMO than patients with private insurance (AOR, 0.55; 95% CI, 0.70-0.75).

Additionally, 25.1% of patients who received ECMO lived in the highest income neighborhoods, while 17.3% of patients living in the highest income neighborhoods received only MV. Patients living in the highest income neighborhoods were more likely to receive ECMO than patients living in the lowest income neighborhoods (AOR, 0.63; 95% CI, 0.60-0.67 ).

Overall, the researchers believe the significance of these differences highlights the need to continue to investigate the disparities that exist in health care and to better understand the factors driving these outcomes.

“Despite the growth of ECMO programs, little effort has been made to ensure equitable access despite multiple examples of disparities in the provision of other critical care resources and treatments,” the study authors wrote. “This study highlights multiple demographic disparities in adult patient selection for ECMO that may be driven by lack of access, restrictive transfer policies, patient preference, and implicit provider biases.

The references

1. Mehta AB, Taylor JK, Day G, et al. Annals of the American Thoracic Society. Disparities in adult patient selection for extracorporeal membrane oxygenation in the United States: a population-level study. Published online April 6, 2023. doi:10.1513/AnnalsATS.202212-1029OC

2. Disparities identified among patients receiving advanced lung support. Press release. National Heart, Lung and Blood Institute. April 6, 2023. Accessed April 5, 2023. https://www.eurekalert.org/news-releases/984931?