WB: Disparities Seen in Patient Selection for Extracorporeal Membrane Oxygenation

Significant disparities exist in patient selection for extracorporeal membrane oxygenation (ECMO), according to a study published online April 5 in the Annals of the American Thoracic Society.

Anuj B. Mehta, M.D., from the University of Colorado in Aurora, and colleagues examined if disparities exist in patient selection for ECMO based on gender, primary insurance, and median income of the patient’s neighborhood. The analysis included data from 18,725 cases of ECMO and 2,170,752 cases of mechanical ventilation (MV) identified through the Nationwide Readmissions Database (2016 to 2019).

The researchers found that among patients treated with ECMO, 36.1 percent were women compared with 44.5 percent of patients treated with MV only (adjusted odds ratio [aOR] for ECMO, 0.73). Of patients treated with ECMO, 38.1 percent had private insurance versus 17.4 percent of patients treated with MV only. Compared with private insurance, patients with Medicaid were less likely to receive ECMO (aOR, 0.55). Compared with patients treated with MV only, patients treated with ECMO were more likely to live in the highest-income neighborhoods (17.3 versus 25.1 percent). ECMO treatment was less likely among patients living in the lowest-income neighborhoods versus those living in the highest-income neighborhoods (aOR, 0.63).

“Based on previous work describing disparities in other areas of health care, we speculate that limited access in some neighborhoods, restrictive/biased inter-hospital transfer practices, differences in patient preferences, and implicit provider bias may contribute the observed differences,” the authors write.