Related Experiment Video
Updated: Aug 18, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children
William T Mahle1, Joseph M Forbess, Paul M Kirshbom
1Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine, 52 Executive Park S., Suite 523, Atlanta, GA 30329, USA. mahlew@kidsheart.com
Insights
Salvage cardiac extracorporeal membrane oxygenation (ECMO) offers reasonable survival for pediatric patients with congenital heart disease. This life-saving therapy is justified by its cost-utility, providing value in terms of quality-adjusted life-years saved.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) indications have expanded to include cardiopulmonary arrest and post-congenital heart surgery support.
- Cardiac patients on ECMO exhibit the poorest survival rates among all recipients.
- Concerns exist regarding the appropriateness, cost, and potential for neurologic disability associated with aggressive ECMO strategies.
Purpose of the Study:
- To evaluate the cost-utility of salvage cardiac extracorporeal membrane oxygenation (ECMO) in pediatric patients.
- To assess survival rates and quality of life in patients receiving salvage cardiac ECMO.
- To determine if salvage cardiac ECMO is a cost-effective intervention for congenital heart disease.
Main Methods:
- Retrospective review of medical records for pediatric patients with congenital heart disease receiving salvage cardiac ECMO (2000-2004).
- Determination of medical care costs post-ECMO initiation using published standards.
- Assessment of survivors' quality of life using the Health Utilities Index Mark II.
Main Results:
- Salvage cardiac ECMO was used in 32 patients (84% with congenital heart disease), with a median age of 2.0 months.
- Survival to hospital discharge was 50%, with 47% survival at 1 year.
- The median cost was $156,324 per patient, yielding a cost-utility of $24,386 per quality-adjusted life-year saved, which is within acceptable ranges.
Conclusions:
- Salvage cardiac extracorporeal membrane oxygenation (ECMO) demonstrates reasonable survival rates in pediatric cardiac patients.
- The therapy is justified on a cost-utility basis, offering a favorable cost-effectiveness ratio.
- ECMO represents a valuable intervention for select pediatric cardiac patients facing critical illness.
Background:
Indications for extracorporeal membrane oxygenation therapy have expanded to include cardiopulmonary arrest and support after congenital heart surgery. Data from a national registry have reported that cardiac patients have the poorest survival of all extracorporeal membrane oxygenation recipients. Concerns have been raised about the appropriateness of such an aggressive strategy, especially in light of the high costs and potential for long-term neurologic disability. We reviewed our experience with salvage cardiac extracorporeal membrane oxygenation to determine the cost-utility, which accounts for both costs and quality of life.
Methods:
Medical records of patients with congenital heart disease receiving salvage cardiac extracorporeal membrane oxygenation between January 2000 and May 2004 were reviewed. Charges for all medical care after the institution of extracorporeal membrane oxygenation were determined and converted to costs by published standards. The quality-of-life status of survivors was determined with the Health Utilities Index Mark II.
Results:
Salvage cardiac extracorporeal membrane oxygenation was instituted in 32 patients (18 for cardiopulmonary arrest and 14 for cardiac failure after heart surgery) at a median age of 2.0 months (range, 4 days to 5.1 years). Congenital heart disease was present in 27 (84%). The mean duration of extracorporeal membrane oxygenation support was 5.1 +/- 4.1 days. Survival to hospital discharge was 50%, including 1 patient bridged to heart transplantation. Survival to 1 year was 47%. The mean score of the Health Utilities Index for the survivors was 0.75 +/- 0.19 (range, 0.41-1.0). The median cost for hospital stay after the institution of extracorporeal membrane oxygenation was USD 156,324 per patient. The calculated cost-utility for salvage extracorporeal membrane oxygenation in this population was USD 24,386 per quality-adjusted life-year saved, which would be considered within the range of accepted cost-efficacy (< USD 50,000 per quality-adjusted life-year saved).
Conclusions:
Salvage cardiac extracorporeal membrane oxygenation results in reasonable survival and is justified on a cost-utility basis.
