Extracorporeal membrane oxygenation referral lowers hospital mortality in H1N1-related ARDS
WEDNESDAY, Oct. 5 (HealthDay News) -- For patients with H1N1-related acute respiratory distress syndrome (ARDS), referral and transfer to an extracorporeal membrane oxygenation (ECMO) center is associated with lower hospital mortality, according to a study published online Oct. 5 in the Journal of the American Medical Association.
Moronke A. Noah, M.R.C.S., from Glenfield Hospital in Leicester, U.K., and colleagues compared hospital mortality between 80 patients with H1N1-related ARDS referred for ECMO (referred, accepted, and transferred), and 195 non-ECMO-referred patients during the H1N1 pandemic in the winter of 2009 to 2010. The ECMO- and non-ECMO-referred participants were matched into 59 pairs using individual matching, 75 pairs by propensity score matching, and 75 pairs by GenMatch matching techniques. Detailed demographic, physiological, and comorbidity data were collected from the matched pairs to measure the survival at hospital discharge (analyzed according to intention-to-treat principle).
The investigators found that 86.3 percent of the ECMO-referred patients received ECMO, and 27.5 percent of them died before discharge from the hospital. The hospital mortality rate of the ECMO-referred and non-ECMO-referred groups was 23.7 and 52.5 percent in the individually matched pairs, 24.0 and 46.7 percent in propensity score matched pairs, and 24.0 and 50.7 percent in GenMatch matched pairs, respectively. The results remained robust to sensitivity analyses; for example, when the inclusion criteria were revised and when the location where the non-ECMO-referred patients were treated was restricted.
"For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients," the authors write.
Several authors disclosed financial relationships with the pharmaceutical and medical device industries, including Chalice Medical, a U.K. distributor for Levitronix ECMO pump, and Avalon Labs, manufacturers of extracorporeal lung support devices.