Gastrointestinal haemorrhage in extracorporeal membrane oxygenation: insights from the national inpatient sample
 
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1
Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
2
Division of Gastroenterology, Henry Ford Hospital, Detroit, MI, United States
3
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, United States
4
Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, United States
5
Division of Cardiology, The Wright Center for Graduate Medical Education, Scranton, PA, United States
6
Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
7
Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, United States
8
Department of Medicine, Westchester Medical Center, Valhalla, NY, United States
9
Division of Cardiology, Lahey Hospital and Medical Center, Burlington, MA, United States
10
Division of Cardiology, Westchester Medical Center, Valhalla, NY, United States
CORRESPONDING AUTHOR
Shantanu Solanki   

Guthrie Robert Packer Hospital
Submission date: 2019-05-31
Final revision date: 2019-08-19
Acceptance date: 2019-09-06
Online publication date: 2021-01-26
 
 
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ABSTRACT
Introduction:
Extracorporeal membrane oxygenation (ECMO) is associated with gastrointestinal haemorrhage (GIH), which may result from coagulo­pathy, systemic inflammation, reduced gastric perfusion, and arteriovenous malformation from non-pulsatile blood flow. Data are limited regarding the burden of this complication in the United States.

Material and methods:
We analysed the National Inpatient Sample (NIS) database for the years 2007 to 2011 to identify hospitalisations in which an ECMO procedure was performed. Hospitalizations complicated by GIH in this cohort were then identified by relevant codes.

Results:
Between 2007 and 2011, ECMO hospitalisations increased from 1869 to 3799 (p < 0.01). The proportion of hospitalisations complicated by GIH increased from 2.12% in 2007 to 7.46% in 2011 (p < 0.01). Gastrointestinal haemorrhage was more common in men (56.7%) and in Caucasians (57.4%). Common comorbidities in this population were renal failure (71%), anaemia (55%), and hypertension (26%). All-cause inpatient mortality showed a numerical but nonsignificant increase from 56.7% to 61.9% (p = 0.49). The average cost of care per hospitalisation with GIH associated with ECMO use increased from 2,420 in 2007 to 5,673 in 2011 (p < 0.01).

Conclusions:
Gastrointestinal haemorrhage during ECMO hospitalisations occurred in small but significantly increasing proportions. The inpatient mortality rate and costs associated with GIH were substantial and increased significantly during the study period.

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ISSN:1734-1922