| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === Background and Objective:
Extracorporeal Membrane Oxygenation, also called ECMO, as the most important life-sustaining treatment is widely used in Taiwan. Due to the advance of medical technology and the accumulation of clinical experiences using ECMO, the survival rate of patients sustained by ECMO has increased up to 40%. National Health Insurance (NHI) in Taiwan has started to reimburse the use of ECMO to sustain life since December 1, 2002. Since then, the patients sustained by ECMO and the reimbursement of the use of ECMO by NHI gradually went up year by year. In 2010, 1,126 patients in Taiwan have been sustained by ECMO, and the total expenditures of using ECMO are around 170 million New Taiwan Dollar (NTD). Because ECMO use in Taiwan raises medical, societal, economical, and ethical issues, this study will explore mainly two aspects of ECMO use: first, the factors associated with hospital mortality will be examined. By doing so the probability of survival can be estimated at the time when ECMO is about to be set up; second, the expenditures of ECMO use will be explored.
Methods:
Data for this study will be derived from the “NTUH ECMO Dataset.” The inclusion criteria are patients aged 18 or older, admitted to NTUH from 2003 to 2009, sustained by ECMO due to acute heart failure caused by acute myocarditis, acute myocardial infarction (AMI), cardiomyopathy, septic shock, and post-cardiotomy. Descriptive statistics regarding the trend of ECMO use and survival will be carried out. the comparison of a continuous independent variable between two groups will be carried out using student t test. The comparison of a dichotomous variable between two groups will be performed using Chi-squared test. The linearity between an independent variable and the dependent variable and the colinearity between two independent variables will be checked using bivariate linear regression analysis or bivariate logistic regression analysis whichever is appropriate. In addition, stepwise multivariate logistic regression analysis will be carried out to establish the model to predict the outcomes of ECMO use. Multivariate linear regression analysis will be performed to establish the model to predict the expenditures of ECMO use.
Results:
In this study , the ECMO patients admitted to NTUH from 1994 to 2009,the survival rate of patients sustained by ECMO has increased. Five risk factors of mortality were indentified:age, cononary artery disease, septic shock, diabetes mellitus, use ECMO during CPR. One independent factors of medical expenditure were indentified: use ECMO during CPR.
Discussion and Suggestion:
Since NTUH has relatively extensive experience with adult patients, which may be quite different from other medical centers with respect to distribution of patient age. The findings should lead to better utilization of ECMO for adult patients in the future.
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