Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic

Extracorporeal membrane oxygenation (ECMO) is a lifesaving medical intervention for patients with severe refractory cardiopulmonary dysfunction. This study aims to characterize hospitalizations and resource use burdens associated with ECMO use during the onset of the pandemic. We performed a retrospective analysis of ECMO use in United States (US) hospitals between 2019 and 2020, utilizing data from the National Inpatient Sample database. Patient demographics, comorbidities, admission characteristics, inpatient mortality, length of hospital stay (LOS), healthcare costs, and ECMO utilization trends were assessed. Of the 17,520 hospitalizations analyzed, the most common reasons for admission were diseases and disorders of the circulatory system (40.5%) and diseases and disorders of the respiratory system (31.2%). The average patient age was 52.5 years, with a male predominance (64.2%). Hospitalizations were predominantly for White Americans (59.5%), followed by Blacks (16.3%) and Hispanics (14.8%). Nearly 88.2% of cases were at an extremely high risk of mortality without intervention. Inpatient mortality was significantly associated with Hispanic descent, a higher Charlson Comorbidity Index (CCI) score, age >60 years, and a higher All Patients Refined Diagnosis Related Groups (APRDRG) risk of mortality. Hospitalizations involving ECMO had a significantly higher inpatient mortality rate compared to non-ECMO hospitalizations (43.1% vs. 2.1%, p60 years, and a higher APRDRG risk. ECMO hospitalizations had longer stays (26 days) and higher costs (US$967,647 per case, US$16.7 billion total) compared to pre-pandemic levels. ECMO use increased significantly from 2019 to 2020, reflecting rising demand.