Cannulation Strategy for Extracorporeal Membrane Oxygenation Does Not Influence Total Hospital Cost

Karen L. Walker, Nadia H. Bakir, Kunal D. Kotkar, Marci S. Damiano, Ralph J. Damiano, Gene Ridolfi, Marc R. Moon, Akinobu Itoh, Muhammad F. Masood

Research output: Contribution to journalArticlepeer-review


Background: The Center for Medicare and Medicaid Services decreased reimbursement rates for peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and venovenous (VV) ECMO 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 the initial cannulation strategy. Outcomes were total hospital cost and clinical resource utilization. Results: There were 29 patients supported on central VA, 72 on peripheral VA, and 37 on VV ECMO. Survival at 30 days 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 =.91). Mean hospital stay was 25.8 days for central vs 21.5 days for peripheral vs 26.2 days for VV (P =.49). Mean intensive care unit stay was 14.1 days for central vs 12.8 days for peripheral vs 7.7 days for VV (P =.25). Mean length of ECMO support was 6.5 days for central vs 6.2 days for peripheral vs 7.8 days for VV (P =.38). Mean ventilator time was 13.0 days for central vs 8.2 days for peripheral vs 10.0 days for VV (P =.06). Hemodialysis was used in 41% central patients, 47% peripheral, and 41% VV (P =.75). Theoretical ECMO reimbursement losses ranged from $1,970,698 to $5,648,219 annually under 2018 Center for Medicare and Medicaid Services rates. Conclusions: ECMO cannulation strategy has minimal impact on resource utilization and hospital cost.

Original languageEnglish
Pages (from-to)49-57
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number1
StatePublished - Jan 2022


Dive into the research topics of 'Cannulation Strategy for Extracorporeal Membrane Oxygenation Does Not Influence Total Hospital Cost'. Together they form a unique fingerprint.

Cite this