How? When patients who haven't responded to defibrillator during EMS transport arrive at the hospital, they are immediately placed on ECPR (extracorporeal membrane oxygenation-assisted CPR, or ECMO-CPR). With cases like this, it's no surprise that we've been fielding a growing number of questions from our members about the promise of ECMO programs.
Though ECMO isn't a new technology, its applications have expanded dramatically to encompass bridge-to-transplant, -recovery, -decision, -transfer, as well as other innovative applications such as ECPR. Alongside new applications, technology improvement and increased awareness of the benefits of early ECMO have increased utilization.
What is ECMO?
ECMO is a support therapy that provides temporary heart-lung bypass percutaneously to allow time for the heart and lungs to heal. ECMO allows programs to serve a wider array of complex and high-risk patients, such as heart transplant and VAD candidates or STEMI patients. Beyond this clinical benefit, ECMO programs can help providers distinguish themselves in the market for advanced heart failure care, as well as achieve financial growth thanks to favorable ECMO reimbursements.
While these forces explain increased interest in ECMO, they may not justify the associated high infrastructure and staff investment for every hospital. Our research has found that to capture the potential clinical and programmatic opportunities of ECMO services, hospitals need to build a well-structured, dedicated ECMO program that can maintain sufficient volumes to support the procedure.
Considerations for launching your own program
Launching and growing such a program is no easy task: only 20% of ECMO-offering providers in the United States treat more than 10 patients annually. According to the Extracorporeal Life Support Organization, the minimum annual case threshold to sustain high-quality outcomes, profitability, and staff retention is approximately six ECMO procedures. Yet the majority of U.S. hospitals treat 1-2 patients—largely due to lack of a structured ECMO strategy. Limited volumes jeopardize ECMO program quality and financial feasibility, especially due to ECMO's high start-up costs and resource-intensive, complex patient population.
There are three main considerations providers need to take into account while building an ECMO program in order to overcome these hurdles:
- First, carefully evaluate your ability to meet the equipment and infrastructure requirements, such as the ECMO machine itself, which can lead to high up-front costs.
- Second, hardwire ECMO team communication and formalize training to improve care coordination and safety for this high-risk patient population.
- Third, focus on creating a program management structure that ensures clear reporting within the ECMO program, consistently tracks financial and clinical performance, and builds strong referral relationships.
To take advantage of the clinical and financial benefits ECMO's growing applications have to offer, providers need to evaluate how ECMO fits into their cardiovascular strategy and balance its growth potential against the cost of building a sustainable program. With new applications still emerging, ECPR among them, ECMO has continued promise for growth, especially for institutions who align investment with their strategy and build a robust program around it.
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Join us the for the 2017-18 Cardiovascular Roundtable national meeting