Health Resource Utilization and Outcomes Among Patients Who Receive Extracorporeal Membrane Oxygenation

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is a high-cost, resource-intensive intervention for severe cardiac and respiratory failure. Survivors of ECMO have healthcare needs that extend beyond their acute hospitalization, placing significant demands on healthcare systems and society. As ECMO use increases globally, understanding the healthcare and economic burden of ECMO survivorship is needed to improve long-term outcomes of ECMO survivors and optimize resource allocation within healthcare systems.

Methods

We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Emcare, Scopus, and Web of Science from inception to October 1, 2024. We included studies published in English that reported post-discharge healthcare resource utilization and costs for adult survivors of ECMO.

Results

From 1889 articles screened, 24 studies met our inclusion criteria. Most were retrospective cohort studies conducted in North America between 2010 and 2024. Sample sizes ranged from 12 to 23,876 patients, with in-hospital mortality rates between 28.5% and 67.4%. Thirty-day readmission rates ranged from 10.0% to 43.8%, with 90-day rates ranging from 21.1% to 53.0%. One study reported a mean 30-day readmission cost of $62,150 (in 2023 US dollars). Only 5 studies (20.8%) reported total healthcare costs up to 6 months and 1 year.

Conclusions

ECMO survivorship is gaining increased attention in research and clinical practice, yet significant gaps remain in our understanding of long-term healthcare resource utilization and costs. Our review reveals very limited information, indicating an urgent need for more comprehensive and granular data to guide clinical and policy decisions and achieve healthcare system efficiency.