Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a lifesaving medical intervention for patients with severe refractory cardiopulmonary dysfunction. This study aims to characterize hospitalizations and resource use burdens associated with ECMO use during the onset of the pandemic. METHODS: We performed a retrospective analysis of ECMO use in United States (US) hospitals between 2019 and 2020, utilizing data from the National Inpatient Sample database. Patient demographics, comorbidities, admission characteristics, inpatient mortality, length of hospital stay (LOS), healthcare costs, and ECMO utilization trends were assessed. RESULTS: Of the 17,520 hospitalizations analyzed, the most common reasons for admission were diseases and disorders of the circulatory system (40.5%) and diseases and disorders of the respiratory system (31.2%). The average patient age was 52.5 years, with a male predominance (64.2%). Hospitalizations were predominantly for White Americans (59.5%), followed by Blacks (16.3%) and Hispanics (14.8%). Nearly 88.2% of cases were at an extremely high risk of mortality without intervention. Inpatient mortality was significantly associated with Hispanic descent, a higher Charlson Comorbidity Index (CCI) score, age >60 years, and a higher All Patients Refined Diagnosis Related Groups (APRDRG) risk of mortality. Hospitalizations involving ECMO had a significantly higher inpatient mortality rate compared to non-ECMO hospitalizations (43.1% vs. 2.1%, p<0.0001). The mean LOS was 26 days for ECMO hospitalizations, with ECMO initiation occurring approximately five days from admission. ECMO-related hospitalizations often involve over 10 unique procedures, resulting in an average healthcare cost of US$967,647 per hospitalization, totaling US$16.7 billion. Comparatively, non-ECMO hospitalizations had shorter LOS and lower mean costs (mean LOS, 4.7 days, and US$52,659, respectively). ECMO utilization increased significantly from 2019 to 2020, reflecting rising demand for this life-saving therapy. CONCLUSION: Compared to non-ECMO hospitalizations, ECMO patients had higher inpatient mortality, associated with Hispanic descent, higher CCI scores, an age >60 years, and a higher APRDRG risk. ECMO hospitalizations had longer stays (26 days) and higher costs (US$967,647 per case, US$16.7 billion total) compared to pre-pandemic levels. ECMO use increased significantly from 2019 to 2020, reflecting rising demand.

Cardiac Angiosarcoma With Pulmonary Metastasis: A Rare and Challenging Case.

Cardiac angiosarcoma is a rare and aggressive malignant tumor arising from the endothelial cells of the heart. It accounts for only a small fraction of all cardiac neoplasms and has a poor prognosis. We present a challenging case of a 20-year-old student who presented exertional dyspnea, palpitation, and occasional chest discomfort. Her clinical picture, radiological and pathological investigations confirm the diagnosis of cardiac angiosarcoma with pulmonary metastasis. This case highlights the importance of early diagnosis and multidisciplinary management for improved patient outcomes.

Atrial Myxoma: An Unusual Etiology of Ischemic Stroke in an Adult Patient.

Atrial myxoma is the most frequent primary cardiac tumor; however, it is a rare, substantial cause of cardiogenic emboli causing a stroke, especially in young adults. A cardiac myxoma has no specific clinical presentation, ranging from constitutional symptoms to non-cardiac symptoms and emboli, which leads to a diagnostic challenge in the clinical process. We report a case of a left atrial myxoma in an adult female who presented with sudden onset of right-sided weakness, headache, and numbness. Imaging confirmed cardiogenic emboli from the cardiac myxoma, which was reflected in an ischemic stroke.