The following is a summary of “Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*,” published in the July 2023 issue of Critical Care by Moynihan et al.

Researchers performed a retrospective study to review the literature on the relationship between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes and assess the evidence’s quality—a literature search between January 2000 and January 2023 was conducted to find studies on the relationship between SDoH and ECMO utilization and outcomes. SDoH may affect ECMO utilization and outcomes, but the relationship is complex and inconsistent.

The methodology followed PRISMA-ScR guidelines, 2 reviewers assessed abstracts and full texts of identified studies. Studies were excluded if they were unavailable in English, had <40 patients, or included periprocedural or mixed mechanical support. Content analysis was performed using a standardized data extraction tool and inductive thematic analysis. 

Biasness risk was assessed using the quality in prognosis studies tool. Out of 8,214 citations, 219 studies were analyzed. Primary focus: race/ethnicity/SES/payer variables (148 studies), ECMO outcomes (114 studies), and utilization (43 studies). SDoH predicted outcomes in 15 studies. Methodologic rigor could have been better (7% used advanced statistics). Associations between ECMO outcomes/utilization and race/ethnicity/SES/payer varied. About 38% reported adverse outcomes/lower use in underrepresented populations, 7% observed improved outcomes/greater use, and 55% had no significant result. Only 26 studies (18%) examined disparities’ mechanistic drivers, mainly individual/hospital-level factors.

The study found an inconsistent relationship between ECMO utilization and outcomes with SDoH. Research gaps in measuring, analyzing, and interpreting SDoH must be addressed.

Source: journals.lww.com/ccmjournal/Fulltext/2023/07000/Health_Disparities_in_Extracorporeal_Membrane.1.aspx