E. B. Pillado1, R. Kashani1, H. Wu1, S. Grant1, C. Hershey1, R. Shemin1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Division Of Cardiac Surgery,Los Angeles, CA, USA
Introduction: Extracorporeal membrane oxygenation (ECMO) has been used to support patients with advanced cardiac and/or pulmonary failure. More recently, venoarterial (VA) ECMO has been used as an adjunct to CPR, which has increased the number of patients on extracorporeal support. With an increase in ECMO utilization worldwide and the need for a cost efficient healthcare system, the present study aimed to evaluate patient outcomes and hospital costs at our institution.
Methods: A retrospective review of the UCLA Health Extracorporeal Life Support Organization (ELSO) database was performed to identify adult patients who underwent VA-ECMO between 2004-2014. Our institutional Society of Thoracic Surgeons Database was used to extract the volume and type of adult cardiac surgeries, defined as patients having procedures requiring cardiopulmonary bypass as well as heart transplants during the same period. Publicly available cost data was obtained for our institution for ECMO services exclusive of bed cost. STATA 12.1 (College Station, TX) was used to run regression analysis on groups.
Results:Out of 263 (33% female) patients who underwent venoarterial ECMO, 117 (44%) were weaned, 55 (21%) bridged to transplantation or mechanical assist device, and 91 (35%) expired while on ECMO. The average time on ECMO was 5.3±0.3 days and the mean age was 50.3 (±1.2). The procedural volume for ECMO showed an annual increase of 27%. Success of wean from ECMO showed a non-significant trend towards improvement over the study period (43% in 2004 to 69% in 2013, p=0.17). The average cost per patient was $36,669(±13,951) in 2004 and $32,776(±15,658) in 2014 (p=0.083). During the same period, there were also significant changes in the volume of cardiac transplants and total number of cases at our institution (total heart transplant, p=0.046, total cardiac surgeries, p=0.001, and VA-ECMO patients, p=0.016) (Figure 1).
Conclusion:We have demonstrated that there was a disproportionate increase in VA-ECMO volume when compared to our institutional volume for cardiac surgical and transplant procedures. With more widespread use of ECMO, the hospital costs have increased over the past decade while the cost per patient has remained relatively constant. This may be explained by having shorter periods on ECMO for each patient. The high institutional burden of ECMO and increasing volumes for the procedure mandate better selection criteria and ECMO protocols in order to maintain a cost-efficient healthcare system
