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Open Access Highly Accessed Research article

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

Yen-Yuan Chen12, Likwang Chen3, Tien-Shang Huang14, Wen-Je Ko56, Tzong-Shinn Chu27, Yen-Hsuan Ni89* and Shan-Chwen Chang104

Author Affiliations

1 Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

2 Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan

3 Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan

4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

5 Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan

6 Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan

7 Department of Primary Care Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

8 Department of Pediatrics, National Taiwan University College of Medicine, No. 1, Road Ren-Ai sec. 1, Taipei 100, Taiwan

9 Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan

10 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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BMC Medical Ethics 2014, 15:21  doi:10.1186/1472-6939-15-21

Published: 4 March 2014

Abstract

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.

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