Health Highlight: Fri. 7, Apr.
Today’s Highlight(s): A look at the role of bias in the use of life support.
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“Disparities identified among patients receiving advanced pulmonary support”
✍🏼 NHLBI Staff Writer(s) • 🌐 Full Article • 📚 Glasp Highlights
BRIEF
A study published this week in the Annals of the American Thoracic Society highlights inequities in life support treatment with extracorporeal membrane oxygenation (more commonly referred to as ECMO) for patients in acute respiratory distress.
About the study’s findings
The study’s listed objective was to “Determine if disparities exist in patient selection for ECMO based on gender, primary insurance, and median income of the patient’s neighborhood.” 1 The researchers discovered that there are differences in who and how often ECMO is utilized in these severe instances.
“After conducting multiple analyses, the researchers found that men received ECMO more often than women, even if they had the same type of insurance and income level.” 2
Aside from gender, there were also notable differences in ECMO treatment for patients using Medicaid vs Medicare and private insurance, as well as disparities related to income level.
“Significant disparities exist in patient selection for ECMO. Female patients, patients with Medicaid, and patients living in the lowest income neighborhoods are less likely to be treated with ECMO.” 1
Could anything else help explain these findings?
In addition to attributing implicit biases to the problem, the researchers observed that other factors could explain why some patients received ECMO while others did not; living near a healthcare center with ECMO equipment was one possibility, and patient preference was another.
“Since ECMO is not available at all medical centers and can be limited where it is offered, about half of all eligible patients receive it.” 2
Despite these possibilities, the researchers still concluded there was enough evidence to point to bias as the main contributing factor; “Despite possible unmeasured confounding, these findings were robust to multiple sensitivity analyses.” 1
Put another way, “[E]ven after controlling for access to ECMO, such as looking at patients who received care at the same hospital, the researchers still found disparities.” 2
Moving forward
These findings are critical not only for drawing attention to the need for equity in healthcare, but also for confronting the reality of dealing with infections like SARS-COVID-19 that in some cases require this level of intervention as a matter of life and death.
In two recent studies, Extracorporeal Membrane Oxygenation Support in Severe COVID-19 and ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis, the use of ECMO was shown to be critical.
“The early outcomes presented here suggest that the judicious use of ECMO support in severe COVID-19 may be clinically beneficial.” 3
ECMO could be beneficial in patients with COVID-19, according to the authors’ meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.” 4
As of today…
The CDC’s Covid Data Tracker has the current number of US Covid cases at 104,242,889, with 12,223 of them reported as hospitalizations; and the total number of Covid deaths at 1,127,104.5
🏷️ #HealthDisparities #Healthcare #ECMO #LifeSupport #COVID19
Notes
“Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study” https://pubmed.ncbi.nlm.nih.gov/37021958/
“Disparities identified among patients receiving advanced pulmonary support” https://www.nih.gov/news-events/news-releases/disparities-identified-among-patients-receiving-advanced-pulmonary-support
“Extracorporeal Membrane Oxygenation Support in Severe COVID-19” https://pubmed.ncbi.nlm.nih.gov/32687823/
“ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis” https://pubmed.ncbi.nlm.nih.gov/34906383/
“Case, Death, & Laboratory Testing Trends by Location” https://covid.cdc.gov/covid-data-tracker/#cases-deaths-testing-trends