Financial implications of using extra corporeal membrane oxygenation following heart transplantation

Background: Primary graft dysfunction(PGD) after heart transplant is associated with high morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) can be used to wean patients from cardiopulmonary bypass. This study retrospectively reviews a single centre experience of post-transplant ECMO in regard to outcomes and associated costs. Methods: Between May 2006 and May 2019, 267 adult heart transplants were performed. We compared donor and recipient variables, ECMO duration and the incidence of renal failure, bleeding, infection and cost analysis between ECMO and non-ECMO groups. Results: ECMO support was required postoperatively to manage PGD in 72 (27%) patients. The mean duration of ECMO support was 6 ± 3.2 days. All demographic variables mean ischaemic time were similar between the groups. There was a significantly higher proportion of VAD explant to transplant in the ECMO group versus non-ECMO (38.2% versus 14.1% (p<0.0001). ECMO patients were associated with longer duration of stay in ITU (p<0.0001) and total hospital stay (p<0.0001). Greater mortality was observed in the ECMO group (p<0.0001). The median cost of providing ECMO was £18,000 [IQR: £12,750-£24,000] per patient with an additional median £35,225 [IQR: £21,487.25-£51,780.75]] for ITU stay whilst on ECMO. The total median cost per patient inclusive of hospital stay, ECMO and dialysis costs was £65,737.50 [IQR: £52,566.50-£95,221.75] in the non-ECMO group compared to £145,415.71 [IQR: £102,523.21-£200,618.96] per patient in the ECMO group (p<0.0001). Conclusion: Patients with PGD following heart transplantation who require ECMO are frequently bridged to a recovery, however, the medium and longer-term survival for these patients is poorer than for patients who have no requirement for ECMO.