Extracorporeal cardiopulmonary resuscitation in Medicare recipients

The use of extracorporeal cardiopulmonary resuscitation (ECPR) in older patients is a controversial practice. The historically high mortality associated with elderly patients who require extracorporeal support frequently dampens the enthusiasm for expending limited, cost-intensive resources on patients of advanced age. We evaluated outcomes in Medicare patients who had suffered sudden acute cardiac arrest and received extracorporeal support.

We used the United States Medicare Inpatient Analytical Files (2018-2023) to evaluate beneficiaries with cardiac arrest who were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO). International Classification of Diseases, Tenth Revision codes were used to define comorbidities and frailty using validated metrics.

Of the 5810 Medicare beneficiaries who were placed on VA-ECMO, 1174 experienced cardiac arrest during the same admission and were categorized as the "ECPR cohort." Their mean Charlson Comorbidity Index score was 2.66 ± 1.36. Approximately one-third had a history of diabetes, liver disease, and chronic renal failure; 52.9% had coronary artery disease, and 65.4% had heart failure. Mortality during hospitalization was 63.8%. Age-stratified 5-year mortality was 69.8% in patients age <70, 78.0% in those age 71% to 80%, and 86.8% in those age >80 years. Conditional on surviving to discharge, mortality was ∼10% at both 1 year and 5 years.

The use of ECPR in Medicare recipients is characterized by high mortality, which further increases with age. This real-world report may help guide the complex clinical decision making in the resuscitation of elderly patients who suffer cardiac arrest.