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Total cost of cannulation strategy for extracorporeal membrane oxygenation

"Limited data are available describing hospital costs and clinical resources required to support ECMO patients" Walker et al (2021).

Abstract:

Background: Center for Medicare Services decreased reimbursement rates for peripheral veno-arterial (VA ECMO) and veno-venous (VV ECMO) extracorporeal membrane oxygenation procedures in October 2018. Limited data are available describing hospital costs and clinical resources required to support ECMO patients.

Methods: All patients supported on ECMO at our institution between March 2017 and October 2018 were identified. Exclusion criteria were cannulation at referring hospitals, organ transplant recipients, and temporary right ventricular support. The cohort was stratified by initial cannulation strategy. Outcomes were total hospital cost and clinical resource utilization.

Results: 29 patients were supported on central VA, 72 on peripheral VA, and 37 on VV ECMO. Thirty-day survival was 48% for central vs 37% for peripheral vs 51% for VV. Hospital costs were $187,848 for central vs $178,069 for peripheral vs $172,994 for VV, P=0.91. Mean hospital stay was 25.8 days for central vs 21.5 for peripheral vs 26.2 for VV, P=0.49. Mean intensive care unit stay was 14.1 days for central vs 12.8 for peripheral vs 7.7 for VV, P=0.25. Mean length of ECMO support was 6.5 days for central vs 6.2 for peripheral vs 7.8 for VV, P=0.38. Mean ventilator time was 13.0 days for central vs 8.2 for peripheral vs 10.0 for VV P=0.06. Hemodialysis was utilized in 41% central, 47% peripheral, and 41% VV patients, P=0.75. Theoretical ECMO reimbursement losses ranged from $1,970,698 to $5,648,219 annually under 2018 Center for Medicare Services rates.

Conclusions: ECMO cannulation strategy has minimal impact on resource utilization and hospital cost.

Reference:

Walker KL, Bakir NH, Kotkar KD, Damiano MS, Damiano RJ, Ridolfi G, Moon MR, Itoh A, Masood MF. Cannulation Strategy for Extracorporeal Membrane Oxygenation Does Not Influence Total Hospital Cost. Ann Thorac Surg. 2021 Feb 10:S0003-4975(21)00236-8. doi: 10.1016/j.athoracsur.2020.12.062. Epub ahead of print. PMID: 33581159.