Tessa Quinn
Extracorporeal Membrane Oxygenation (ECMO) is a life-saving procedure that supports heart and lung function in critical conditions. ECMO procedures have been performed in the United States for decades, and their use is on the rise. The number of hospitals offering ECMO treatment varies across the country, with California having the highest number of ECMO centers (56) and Iowa the lowest (4). ECMO is considered a valuable treatment option, particularly for patients with severe cardiac and pulmonary issues, and it has become an essential tool for hospitals, with an increasing number of career opportunities in this field.
| Characteristics | Values |
|---|---|
| Number of hospitals offering ECMO | 4 (Iowa) to 56 (California) across the states |
| State with the highest density of ECMO centres per population | Nebraska (4.8 hospitals/1,000,000 people) |
| States with the highest density of ECMO centres per land area | North Carolina and Washington (1.5 hospitals/1,000 square miles) |
| Number of ECMO retrievals centres | 63 |
| Number of large-volume ECMO centres | 20 (32%) |
| Number of medium-sized ECMO centres | 27 (43%) |
| Number of hospitals managing less than 50 ECMO patients per year | 16 (25%) |
| Type of ECMO centres | 49% university hospitals, 36.5% private institutions, 14.5% university-affiliated or community hospitals |
| Company providing ECMO services to over 1,000 hospitals | SpecialtyCare |
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What You'll Learn
- ECMO is a life-saving procedure for patients with severe heart and lung conditions
- ECMO use is on the rise in the US, with a 433% increase in adult cases from 2006 to 2011
- ECMO retrievals are performed by specialized teams from tertiary medical centres
- ECMO programs can increase revenue and patient care opportunities for hospitals
- ECMO therapy may reduce mortality rates in patients with cardiac issues
ECMO is a life-saving procedure for patients with severe heart and lung conditions
Extracorporeal Membrane Oxygenation (ECMO) is a life-saving procedure for patients with severe heart and lung conditions. It involves draining blood from the vascular system, circulating it outside the body using a mechanical pump, and reinfusing it back into the blood circulation. This process ensures that the blood is adequately oxygenated and that waste gases like carbon dioxide are removed. ECMO acts as a form of life support, maintaining blood flow and oxygenation to vital organs while giving the heart and lungs time to rest and recover.
ECMO is often used in emergency care settings for patients experiencing severe trauma, infection, cardiac arrest, lung failure, or heart failure. It can also be utilised as a bridge to transplantation, supporting patients awaiting a heart or lung transplant. The duration of ECMO treatment depends on the underlying condition and can range from a few hours or days to several weeks.
The ECMO procedure requires a minor surgical operation performed in the patient's room under sedation. Catheters are inserted into the patient's artery or vein, and an X-ray confirms the correct placement of the tubes. Patients on ECMO often require breathing support and are placed on a ventilator to allow their lungs to heal. Additionally, supplemental nutrition is provided intravenously or through a gastric tube.
ECMO therapy is complex and carries certain risks, including the possibility of blood clotting, bleeding, and infection. However, it has become an essential tool in critical care, especially with the rise in cardiac disease and the demand created by the COVID-19 pandemic. The global ECMO market is growing, and hospitals are recognising the benefits of investing in ECMO programs to improve patient care and avoid transfers to other hospitals.
In the United States, ECMO is offered at over 1,100 hospitals nationwide, with UCHealth University of Colorado Hospital (UCH) being recognised as an ECMO Center of Excellence by the Extracorporeal Life Support Organization (ELSO). UCH performs 70-90 ECMO cases annually, ranking among the top ECMO centres nationally. The increasing demand for ECMO and advancements in technology are making it more accessible and safer to perform, even in remote areas.
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ECMO use is on the rise in the US, with a 433% increase in adult cases from 2006 to 2011
Extracorporeal Membrane Oxygenation (ECMO) therapy has been used since the 1970s to provide respiratory and hemodynamic functional support to patients with cardiopulmonary failure. It involves draining blood from the vascular system, circulating it outside the body using a mechanical pump, and reinfusing it into the blood circulation. This process helps saturate the blood with oxygen and filter out carbon dioxide.
The use of ECMO therapy is on the rise in the US, with a 433% increase in adult cases from 2006 to 2011. This increase in usage has been attributed to several factors, including the aging population and the rise of cardiac disease. Cardiovascular disease is the leading cause of death in the US, with one person dying of heart disease every 33 seconds. ECMO therapy can help reduce the mortality rate from heart disease and support patients with cardiac disorders.
Additionally, ECMO therapy has evolved past its reputation as a "last resort" treatment and is now being utilized for a wider range of conditions, including pneumonia, sudden cardiac arrest, pulmonary embolism, severe asthma, sepsis, and more. It can also be used as a bridge to transplantation and organ donation. The global ECMO market is currently valued at $504 million and is expected to reach $793 million by 2033, with average reimbursements of over $100,000 per patient.
The COVID-19 pandemic also contributed to the increased demand for ECMO therapy. ECMO technology is becoming safer, more accessible, and easier to transport to remote or rural areas. Hospitals are recognizing the benefits of investing in ECMO programs to increase revenue and improve patient care. ECMO programs help hospitals retain patients and avoid transferring them to other facilities, resulting in better patient outcomes and increased profitability.
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ECMO retrievals are performed by specialized teams from tertiary medical centres
Extracorporeal Membrane Oxygenation (ECMO) is a life-saving cardiopulmonary support procedure that has been used for decades to support patients with respiratory and/or circulatory failure. ECMO procedures are typically performed by cardiothoracic surgeons (CTS) but, due to limited CTS availability, there is a mismatch between ECMO demand and CTS accessibility for remote cannulations. As such, ECMO retrievals are often performed by specialized teams from tertiary medical centres. These teams travel to referring hospitals to implant ECMO and stabilize the patient for transportation back to the ECMO centre for further care.
A well-organized regional ECMO centre with remote cannulation and retrieval capabilities can provide potentially life-saving interventions to patients treated at smaller hospitals. The feasibility of a retrieval cardiogenic shock team operating within a regional hub-and-spoke model was demonstrated in the cardiac-RESCUE pilot study in France. Tertiary ECMO transportation involves a rescue ECMO team from a regional ECMO centre travelling to a facility, placing the patient on ECMO, and then transporting them to a different ECMO centre due to limited ECMO capacity at the original hospital.
ECMO retrievals require a diverse team of specialists, including an ECMO physician, ECMO coordinator, ECMO specialist or perfusionist, and a respiratory therapist. All members of the retrieval team must be able to cannulate both V-A and V-V ECMO. For V-A ECMO cannulations, the team will first attempt to place a 5 or 7 French (Fr) antegrade reperfusion cannula, followed by a 17 Fr, 23 cm long arterial and 23 or 25 Fr venous femoral drainage cannula, and the initiation of ECLS support. If antegrade cannula placement is unsuccessful, the team will consult cardiovascular or vascular surgery for antegrade catheter placement via cutdown upon returning to the institution.
The use of ECMO therapy continues to rise in the US and worldwide, and ECMO programs are becoming a promising long-term investment for hospitals. ECMO can be used to treat a range of conditions, including pneumonia, sudden cardiac arrest, pulmonary embolism, severe asthma, sepsis, and more. It can also be used as a bridge to transplantation and organ donation.
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ECMO programs can increase revenue and patient care opportunities for hospitals
Extracorporeal Membrane Oxygenation (ECMO) therapy is becoming an increasingly attractive prospect for hospitals in the US and worldwide. ECMO is a life-saving cardiopulmonary support procedure that drains blood from the vascular system, circulates it outside the body using a mechanical pump, and reinfuses it into the blood circulation. This process ensures the blood is completely saturated with oxygen and filters out waste gases like carbon dioxide.
For many years, ECMO has been considered a salvage or last-resort therapy for critically ill patients. However, the COVID-19 pandemic significantly increased the demand for ECMO globally and highlighted its potential to save those who otherwise would have died. Additionally, evolving ECMO technologies are making the procedure safer, easier to transport to remote areas, and more accessible in emergencies. As a result, ECMO is becoming a promising long-term investment for hospitals, with the global ECMO market estimated to reach a value of $793 million by 2033.
From a financial perspective, ECMO is highly profitable for hospitals. Among Medicare-covered admissions, ECMO receives the third-highest payment within their Diagnosis-Related Group (DRG) payment model. For patients covered by Medicaid, the reimbursement for this life-saving service is often the highest reimbursed intervention in most states. The net revenue of ECMO can be well over $100,000 per patient, and in some cases, can exceed one million dollars per case with commercial payers.
In addition to the financial benefits, ECMO programs can enhance a hospital's reputation and standing in the community and the wider healthcare field. Hospitals with strong ECMO programs can serve more patients, improve patient outcomes, and strengthen their reputation for expertise and patient care. Furthermore, ECMO programs help hospitals avoid patient transfers to other facilities, retaining revenue that would otherwise have been lost.
However, establishing an ECMO program can be challenging and costly. Hospitals must consider the expense of equipment, disposables, new personnel, specialized training, and more. Additionally, multidisciplinary ECMO teams require regular experience and practice to perform at their best and ensure positive patient outcomes. Hospitals should carefully assess their opportunity with ECMO and build realistic expectations for program growth and success over time.
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ECMO therapy may reduce mortality rates in patients with cardiac issues
Extracorporeal Membrane Oxygenation (ECMO) is a life-saving procedure that provides cardiopulmonary support to patients in severe, life-threatening conditions. It involves draining blood from the vascular system, circulating it outside the body using a mechanical pump, and reinfusing it back into the blood circulation. This process ensures oxygen saturation of the blood and the removal of waste gases like carbon dioxide.
ECMO therapy has been shown to be particularly effective in patients with cardiac issues. Cardiovascular disease is the leading cause of death in the United States, with one person dying of heart disease every 33 seconds. Over 900,000 cardiac surgeries are performed each year, and ECMO therapy may play a crucial role in reducing mortality rates associated with heart disease. The Advisory Board reports that the survival rate for out-of-hospital cardiac arrest could increase from 10% to 40% with ECMO use, which could result in saving 140,000 lives.
Several studies have demonstrated the potential benefits of ECMO therapy in reducing mortality rates among cardiac patients. A meta-analysis of randomized controlled trials found no significant difference in 30-day all-cause mortality between patients who received ECMO therapy and those who received standard medical therapy. However, the same meta-analysis showed a significant reduction in 12-month all-cause mortality with the use of ECMO, indicating its potential long-term benefits.
Additionally, ECMO therapy has been found to be valuable in specific cardiac conditions. For instance, in patients with cardiogenic shock following acute myocardial infarction, ECMO therapy may not improve 30-day mortality but has been associated with a significant reduction in 12-month mortality. This suggests that while ECMO may not provide immediate survival benefits in all cases, it can contribute to improved long-term outcomes for cardiac patients.
Furthermore, ECMO therapy can be a valuable bridge to transplantation and organ donation. It can support reversible heart disorders and allow time for the lungs to rest and heal while ensuring adequate oxygenation of the blood. This versatility of ECMO therapy makes it an invaluable tool in the management of cardiac issues and a promising investment for hospitals and healthcare organizations.
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Frequently asked questions
The number of hospitals that offered ECMO ranged from 4 (Iowa) to 56 (California) across the states. Nebraska had the highest density of ECMO centers per population (4.8 hospitals/1,000,000 people). North Carolina and Washington had the highest density of ECMO centers per land area (1.5 hospitals/1,000 square miles).
ECMO stands for Extracorporeal Membrane Oxygenation. It is a lifesaving cardiopulmonary support procedure during which blood is drained from the vascular system, circulated outside the body using a mechanical pump, and reinfused into the blood circulation.
ECMO can maintain oxygen supply to the body even when the lungs are resting. It can support reversible heart disorders and allow the lungs to rest and heal while it takes care of oxygenating the blood.
