Outcome, compliance with inclusion criteria and cost of extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest: A retrospective cohort study

Introduction: The primary aim was to describe the outcome, the compliance with inclusion criteria and the characteristics of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). The secondary aim was to calculate the cost of ECPR for the patients and the public Belgian healthcare system.

Methods: Single-centre retrospective cohort study in Antwerp University Hospital. We included all patients who underwent ECPR for OHCA from 2018 to 2020. Medical records were assessed to determine the clinical outcome and invoices were assessed to calculate the charged fees. We collected all relevant cost components at the most detailed level (micro costing technique).

Results: Sixty-five patients who received ECPR for OHCA were included. Thirty-eight patients (58%) died within one week after ECPR initiation. After one year, twelve patients (18.5%) were still alive of which ten (15.4%) had a good neurological outcome (Cerebral Performance Category (CPC) 1 or 2). Forty-nine patients (75.4%) met the ECPR inclusion criteria. A total of 2,552,498.34 euro was charged. The patients and the public Belgian healthcare system contributed to a 255,250 euro cost for each survivor after one year with good neurological outcome.

Conclusion: Our analysis highlights the complex interplay between clinical efficacy and financial implications in the utilization of ECPR. While ECPR demonstrates potential in improving survival rates and neurological outcomes among cardiac arrest patients, its adoption presents substantial economic challenges. Inappropriate patient selection may lead to significant increases in resource utilisation without improved outcome.