Cost of Providing Extracorporeal Membrane Oxygenation in Pediatric and Neonatal Populations

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving support modality in children with refractory cardiorespiratory failure. However, ECMO is one of the costliest interventions available to support critically ill children. Understanding ECMO cost is increasingly important in the current era of resource limitations necessitating improved cost-effective use. We hypothesized that hospitalization and care component costs related to ECMO can be predicted and would vary by indication.


Methods: We queried the Pediatric Health Information System (PHIS) database to identify all patients supported with ECMO at freestanding pediatric hospitals from January 2016 through December 2024. Using ICD-10 diagnostic and procedure codes, we classified cases by indication and subdivided total cost based on standard ECMO care to identify which interventions were the most significant contributors. The hospital charges were converted into costs using hospital and year specific cost to charge ratios and inflated to 2024 dollars using the medical component of the Consumer Price Index.


Results: Of the 11,233 patients who required ECMO support reported to the PHIS database from January 2016 through December 2024, 10,184 patients had complete billing data and were cared for in hospitals participating in PHIS during the study period. The most common indications were nonsurgical heart disease (39.1%), cardiac surgery (27%), and pediatric respiratory failure (13.6%). The median ECMO run was 6 days [4,11], and the median cost of hospitalization while on ECMO per case ranged across conditions from $37,594 to $353,087. The most costly indications included congenital diaphragmatic hernia ($353,087), cardiac surgery ($237,845), non-surgical heart disease ($183,180). Regardless of indication, the greatest contributors to total cost included clinical costs ($58,434), laboratory costs ($36,674), and room & board costs ($36,324).


Conclusions: The cost of supporting children with ECMO remains high, with statistically significant differences in cost across ECMO indications. Identifying that clinical, laboratory, and room & board costs are major drivers of overall cost across all indications can guide cost effectiveness research and cost mitigation strategies.