Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example

BMC Medical Ethics

Shan-Chwen Chang⁴  Yen-Hsuan Ni⁵  Tzong-Shinn Chu³  Wen-Je Ko¹  Tien-Shang Huang⁴  Likwang Chen²  Yen-Yuan Chen⁶ 

[1] Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan;Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;Department of Primary Care Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan;Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan

关键词: Trend;    Media;    Cardiopulmonary resuscitation;    Extra-corporeal membrane oxygenation;    Life-sustaining treatment;   

Others  :  799570
DOI  :  10.1186/1472-6939-15-21

 received in 2013-06-08, accepted in 2014-02-26,  发布年份 2014

【 摘 要 】

Background

Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.

Methods

Taiwan’s extracorporeal membrane oxygenation uses from 2000 to 2009 were collected from National Health Insurance Research Dataset. The number of the worldwide extracorporeal membrane oxygenation cases was mainly estimated using Extracorporeal Life Support Registry Report International Summary July 2012. The trend of Taiwan’s crude annual incidence rate of extracorporeal membrane oxygenation use was compared with that of the rest of the world. Each trend of extracorporeal membrane oxygenation use was examined using joinpoint regression.

Results

The measurement was the crude annual incidence rate of extracorporeal membrane oxygenation use. Each of the Taiwan’s crude annual incidence rates was much higher than the worldwide one in the same year. Both the trends of Taiwan’s and worldwide crude annual incidence rates have significantly increased since 2000. Joinpoint regression selected the model of the Taiwan’s trend with one joinpoint in 2006 as the best-fitted model, implying that the significant social events in 2006 were significantly associated with the trend change of extracorporeal membrane oxygenation use following 2006. In addition, significantly social events highlighted by the media are more likely to be associated with the increase of extracorporeal membrane oxygenation use than being fully covered by National Health Insurance.

Conclusions

Significant social events, such as a well-known person’s successful extracorporeal membrane oxygenation use highlighted by the mass media, are associated with the use of life-sustaining treatment such as extracorporeal membrane oxygenation.

【 授权许可】

   
2014 Chen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, Gerbode F: Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972, 286(12):629-634.
• [2]Crow S, Fischer AC, Schears RM: Extracorporeal life support: utilization, cost, controversy, and ethics of trying to save lives. Semin Cardiothorac Vasc Anesth 2009, 13(3):183-191.
• [3]Delius RE, Bove EL, Meliones JN, Custer JR, Moler FW, Crowley D, Amirikia A, Behrendt DM, Bartlett RH: Use of extracorporeal life support in patients with congenital heart disease. Crit Care Med 1992, 20(9):1216-1222.
• [4]Kolla S, Awad SS, Rich PB, Schreiner RJ, Hirschl RB, Bartlett RH: Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg 1997, 226(4):544-566.
• [5]Extracorporeal Life Support Organization: International summary: ECLS registry report. July 2012
• [6]Taipei Times: Tearful Jason Hu thanks hospital staff, everyone who has prayed for his wife. http://www.taipeitimes.com/News/front/archives/2006/11/22/2003337387 webcite (Accessed on January 11, 2014)
• [7]Taipei Times: Shaw remains in critical condition, mayor stable. http://www.taipeitimes.com/News/taiwan/archives/2006/11/20/2003337108 webcite (Accessed on January 11, 2014)
• [8]Epoch Times: ECMO used to rescue the TV celebrity. http://www.epochtimes.com/b5/7/1/1/n1575832.htm webcite (Accessed on January 11, 2014)
• [9]Taipei Times: NTU doctors find better technique for cardiac arrests. http://www.taipeitimes.com/News/taiwan/archives/2008/07/20/2003417960 webcite (Accessed on January 11, 2014)
• [10]Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY: Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008, 372(9638):554-561.
• [11]Rajagopal SK, Almond CS, Laussen PC, Rycus PT, Wypij D, Thiagarajan RR: Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: a review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010, 38(2):382-387.
• [12]Morris MC, Ittenbach RF, Godinez RI, Portnoy JD, Tabbutt S, Hanna BD, Hoffman TM, Gaynor JW, Connelly JT, Helfaer MA, Spray TL, Wernovsky G: Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 2004, 32(4):1061-1069.
• [13]Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, Haft JW, Swaniker F, Arbabi S, Hirschl RB, Bartlett RH: Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 2004, 240(4):595-605. discussion 605–597
• [14]Bartlett RH, Roloff DW, Custer JR, Younger JG, Hirschl RB: Extracorporeal life support: the University of Michigan experience. JAMA 2000, 283(7):904-908.
• [15]Hsu KH, Chi NH, Yu HY, Wang CH, Huang SC, Wang SS, Ko WJ, Chen YS: Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center’s experience. Eur J Cardiothorac Surg 2011, 40(3):682-688.
• [16]Chung SY, Sheu JJ, Lin YJ, Sun CK, Chang LT, Chen YL, Tsai TH, Chen CJ, Yang CH, Hang CL, Leu S, Wu CJ, Lee FY, Yip HK: Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single-center observational study. Circ J 2012, 76(6):1385-1392.
• [17]World Population Prospects: the 2010 Revision http://esa.un.org/wpp/unpp/panel_population.htm webcite (Accessed on January 11, 2014)
• [18]Least developed countries http://en.wikipedia.org/wiki/Least_developed_country webcite (Accessed on January 11, 2014)
• [19]Kim HJ, Fay MP, Feuer EJ, Midthune DN: Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000, 19(3):335-351.
• [20]Cancer Control and Population Sciences, Surveillance Research, National Cancer Institute: Model estimation and selection methods. http://surveillance.cancer.gov/joinpoint/faq/ webcite (Accessed on January 11, 2014)
• [21]Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute: Joinpoint Regression Program, Version 3.5.2. National Cancer InstituteOctober 2009
• [22]Green TP, Timmons OD, Fackler JC, Moler FW, Thompson AE, Sweeney MF: The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Crit Care Med 1996, 24(2):323-329.
• [23]Morris A, Wallace C, Menlove R, Clemmer T, Orme J Jr, Weaver L, Dean N, Thomas F, East T, Pace N: Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome [published erratum appears in Am J Respir Crit Care Med 1994 Mar;149(3 Pt 1):838]. Am J Respir Crit Care Med 1994, 149(2):295-305.
• [24]Cox CS, Zwischenberger JB, Graves D: Mortality from ARDS remains unchanged. Am Rev Respir Dis 1992, 145:A83-A83.
• [25]Moler FW, Custer JR, Bartlett RH, Palmisano JM, Akingbola O, Taylor RP, Maxvold NJ: Extracorporeal life support for severe pediatric respiratory failure: an updated experience 1991–1993. J Pediatr 1994, 124(6):875-880.
• [26]Grilli R, Freemantle N, Minozzi S, Domenighetti G, Finer D: Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev 2002, (1):CD000389.
• [27]Diem SJ, Lantos JD, Tulsky JA: Cardiopulmonary resuscitation on television? Miracles and misinformation. N Engl J Med 1996, 334(24):1578-1582.
• [28]Kao TM, Wang CH, Chen YC, Ko WJ, Chang SC: The first case of severe novel H1N1 influenza successfully rescued by extracorporeal membrane oxygenation in Taiwan. J Formos Med Assoc 2009, 108(11):894-898.
• [29]Taipei Times: Taiwan reports first case of A(H1N1) flu. http://www.taipeitimes.com/News/front/archives/2009/05/21/2003444145 webcite (Accessed on January 11, 2014)
• [30]Roy AD, Chen L, Santucci K: What do pediatric residents know about malpractice? Pediatr Emerg Care 2011, 27(7):586-590.
• [31]Burkle CM, Martin DP, Keegan MT: Which is feared more: harm to the ego or financial peril? A survey of anesthesiologists’ attitudes about medical malpractice. Minn Med 2012, 95(9):46-50.
• [32]Brett AS: Inappropriate requests for treatments and tests. In 20 Common Problems-Ethics in Primary Care. Edited by Sugarman J. New York: The McGraw-Hill Companies, Inc; 2000:3-12.
• [33]Youtube: Jason Hu: everyone please help to save my wife. http://www.youtube.com/watch?v=uGdMCAZgdSk webcite (Accessed on January 11, 2014)
• [34]Youtube: The female rider’s Glasgow Coma Scale was four, and her husband broke down for medical assistance. http://www.youtube.com/watch?v=PJwQG15sN-k webcite (Accessed on January 11, 2014)
• [35]Gordis L: From association to causation: driviing inferences from epidemiologic studies. In Epidemiology. 4th edition. Edited by Gordis L. Philadelphia, PA: Saunders Elsevier; 2009:234-236.
• [36]National Health Insurance Administration, Ministry of Health and Welfare, Taiwan: National health insurance statistics 2011. http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&webdata_id=3352 webcite (Accessed on February 1, 2014)
• [37]Extracorporeal life support organization http://www.elso.med.umich.edu/Default.htm webcite (Accessed on January 11, 2014)