Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation.
BACKGROUND
An increasing number of centers are using active rehabilitation and ambulation for critically ill patients on extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. This investigation assessed the economic impact at a single center of ambulatory versus non-ambulatory ECMO strategies as a bridge to lung transplantation.


METHODS
We conducted a single-center retrospective cohort analysis of all subjects supported with ECMO as a bridge to lung transplantation (N = 9) from 2007 to 2012. Subjects who were rehabilitated while supported with ECMO before lung transplantation were compared with those who were not rehabilitated during ECMO. Hospital cost data for the month before transplantation through 12 months after the initial post-transplant hospital discharge were compared.


RESULTS
The median cost (interquartile range [IQR]) in the 30 d before transplant for the ambulatory cohort was $88,137 (IQR $38,589-$122,111) compared with $52,124 (IQR $23,824-$69,929) for the non-ambulatory cohort (P = .08). The median post-transplant ICU cost for the ambulatory cohort was $38,468 (IQR $23,611-$64,126) compared with $143,407 (IQR $112,199-$168,993) for the non-ambulatory cohort (P = .01). The median total hospital cost for subjects supported with ambulatory ECMO was $213,086 (IQR $166,767-$264,536) compared with $273,291 (IQR $237,299-$374,175) for non-ambulatory ECMO subjects (P = .05). The median total cost for the ambulatory cohort was $268,194 (IQR $219,972-$517,320) compared with $300,307 (IQR $274,262-$394,913) for the non-ambulatory cohort (P = .14).


CONCLUSIONS
Subjects supported with ambulatory ECMO had a 22% ($60,204) reduction in total hospital cost, 73% ($104,939) reduction in post-transplant ICU cost, and 11% ($32,133) reduction in total cost compared with non-ambulatory ECMO subjects. This analysis demonstrates the potential economic benefit of rehabilitation and ambulation during ECMO compared with a traditional strategy.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina. jbain@mcvh-vcu.edu.
Jesse C
JC
Bain
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
David A
DA
Turner
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
Kyle J
KJ
Rehder
Duke Clinical Research Institute.
Eric L
EL
Eisenstein
Division of Cardiovascular and Thoracic Surgery, Department of Surgery.
R Duane
RD
Davis
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
Ira M
IM
Cheifetz
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina.
David W
DW
Zaas
D000293:Adolescent; D003422:Critical Care / Q000191:economics; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000379:methods*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008171:Lung Diseases / Q000191:economics / Q000534:rehabilitation* / Q000628:therapy; D016040:Lung Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D016138:Walking; D055815:Young Adult
economics; extracorporeal membrane oxygenation; lung transplantation; rehabilitation; respiratory failure