Financial and clinical outcomes of extracorporeal mechanical support.
BACKGROUND
Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period.


METHODS
A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes.


RESULTS
Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06).


CONCLUSIONS
In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO.
UCLA Anderson School of Management, Los Angeles, California.
Ryan
R
Chiu
UCLA Division of Cardiac Surgery, Los Angeles, California.
Eric
E
Pillado
UCLA Division of Cardiac Surgery, Los Angeles, California.
Sohail
S
Sareh
UCLA Division of Cardiac Surgery, Los Angeles, California.
Kim
K
De La Cruz
UCLA Division of Cardiac Surgery, Los Angeles, California.
Richard J
RJ
Shemin
UCLA Division of Cardiac Surgery, Los Angeles, California.
Peyman
P
Benharash
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000401:mortality*; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
cardiac surgery; cost analysis; extracorporeal membrane oxygenation (ECMO); outcomes; resuscitation; surgical critical care