Publications Lincy Institute

10-2018

Extracorporeal Membrane Oxygenation (Ecmo) Access in the 30 Extracorporeal Membrane Oxygenation (Ecmo) Access in the 30

Largest U.S. Metros Largest U.S. Metros

Kaylie Pattni Seattle Pacific University, pattnik@spu.edu

Caitlin J. Saladino University of Nevada, Las Vegas

William E. Brown UNLV, william.brown@unlv.edu

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Repository Citation Repository Citation Pattni, K., Saladino, C. J., Brown, W. E. (2018). Extracorporeal Membrane Oxygenation (Ecmo) Access in the 30 Largest U.S. Metros. Health Fact Sheet No. 1 1-6. Available at:Available at: https://digitalscholarship.unlv.edu/lincy_publications/44

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EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) ACCESS IN THE 30 LARGEST U.S. METROS

Health Fact Sheet No. 1| October 2018 Prepared by: Kaylie Pattni, Caitlin J. Saladino, and William E. Brown, Jr.

PURPOSE:

This Fact Sheet highlights the locations and availability of ECMO (extracorporeal membrane oxygenation) medical capacity in the 30 largest U.S. metropolitan statistical areas (MSAs). Using the ELSO (Extracorporeal Life Support Organization) registry,1 the Table that follows shows all registered ELSO hospitals in the top 30 MSAs, and their respective type(s) of ECMO access.

WHAT IS ECMO?

ECMO is an acronym for “extracorporeal membrane oxygenation.” The ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When you are connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into your body. There are two types of ECMO. The VA ECMO is connected to both a vein and an artery and is used when there are problems with both the heart and lungs. The VV ECMO is connected to one or more veins, usually near the heart, and is used when the problem is only in the lungs. Two varieties of ECMO machines exist to save lives. Pediatric ECMO machines are tailored to the heath needs of children and adult ECMO machines serve the young adult through senior age population.

WHEN IS ECMO USED?

According to the University of California, San Francisco Medical Center,2 ECMO is used: • For patients recovering from heart failure, or lung failure or heart surgery. • As a bridge option to further treatment, when doctors want to assess the state of other organs such as the

kidneys or brain before performing heart or lung surgery. • For support during high-risk procedures in the cardiac catheterization lab. • As a bridge to a heart assist device, such as left ventricular assist device (LVAD). • As a bridge for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, which makes

the patient a better candidate for transplant.

HOW MUCH DOES ECMO COST?

ECMO is very expensive, available only in certain centers and not standard therapy, making it just the kind of care that causes geographic disparity in medical costs.3 The mean estimated cost for an ECMO procedure is $73,122. The mean estimated total hospital costs, including pre- and post-ECMO procedures, is $213,246.4

1 ELSO Center ID List of Hospitals with ECMO access can be found at www.elso.org/Registry/SupportDocuments/CenterIDList.aspx. In total, there are 702 centers, located in the U.S. and internationally. The total number of registered centers in the U.S. is 236. For the purpose of this fact sheet, researchers narrowed their scope to those 236 ELSO registered centers located in the U.S. and then narrowed to those located within the top 50 U.S. metros in population size. Some ECMO administering hospitals not registered through ELSO were also identified through the research (Like UCSF Medical Center) and were subsequently included. The table displays the ECMO access type (pediatric or adult) of the hospitals within the top 30 U.S. metros. 2 UCSF Medical Center. Extra Corporeal Membrane Oxygenation. Retrieved from www.ucsfhealth.org/treatments/extracorporeal_mechanical_oxygenation 3 “The High Price of a Medical Miracle,” Retrieved from: www.washingtonpost.com/wp-dyn/content/article/2008/05/23/AR2008052302564.html 4 ECMO machine technology can be reviewed in Mishra, V., et al. (2010). Cost of extracorporeal membrane oxygenation: Evidence from the Rikshospitalet University Hospital, Oslo, Norway. European Journal of Cardio-Thoracic Surgery, 37(2), 339-342.

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The Table offers a list of the top 30 U.S. MSAs, ranked by population size. Each of the top 30 MSAs has at least one hospital with access to ECMO medical technology. While every hospital listed in the Table has ECMO access, not all hospitals possess both adult and pediatric ECMO. Therefore, this Table identifies the type of ECMO access present (adult, pediatric, or both). A check mark (ü) signals the ECMO access type at a given hospital, a blank box signifies the absence of ECMO access, and a dash (-) indicates that the status of ECMO access is unknown. A red shaded box signifies that a particular hospital is specifically designated as a Children’s Hospital.

Table: ECMO ACCESS IN THE 30 LARGEST U.S. METROS

MSA

RA

NK

METRO

S

PO

PU

LATIO

N

# O

F H

OSP

ITA

LS

WIT

H E

CM

O A

CC

ES

S

PARTICIPATING MEDICAL CENTERS WITH ECMO ACCESS

AD

ULT

PED

IATRIC

1 New York-Newark-Jersey

City, NY-NJ-PA MSA 20,320,876 11

Columbia University Medical Center, New York-Presbyterian Hospital ü ü Montefiore Medical Center ü ü NYU Langone Health ü - Maimonides Medical Center ü ü Robert Wood Johnson University Hospital ü ü The Bristol-Myers Squibb Children's Hospital ü Cohen Children's Medical Center ü Northwell Health - - Christiana Care Health System - -

Mount Sinai Hospital ü Newark Beth Israel Medical Center ü ü

TOTAL 6 8

2 Los Angeles-Long Beach-

Anaheim, CA MSA 13,353,907 6

CHOC Children's Hospital ü Huntington Memorial Hospital ü Children's Hospital of Los Angeles ü UCLA Ronald Reagan Medical Center & UCLA Mattel Children’s Hospital ü ü Cedars-Sinai Medical Center ü ü Keck Medical Center of USC ü -

TOTAL 3 5

3 Chicago-Naperville-Elgin,

IL-IN-WI MSA 9,533,040 10

Ann & Robert H. Lurie Children's Hospital of Chicago ü Advocate Children's Hospital, Park Ridge ü The University of Chicago Medicine Comer Children’s Hospital ü Advocate Children's Hospital - Oak Lawn ü Rush University Medical Center ü ü Advocate Condell Medical Center ü - NorthShore University Health System ü -

Northwestern Memorial Hospital ü - The University of Chicago Medical Center ü ü Advocate Aurora Good Samaritan Hospital - -

TOTAL 5 6

4 Dallas-Fort Worth-Arlington, TX MSA

7,399,662 7

Children's Medical Center of Dallas ü Cook Children's Medical Center ü Medical City Children's Hospital ü Baylor University Medical Center ü Baylor Scott & White All Saints Medical Center ü

The Heart Hospital Baylor Plano - - UT Southwestern Medical Center ü ü

TOTAL 3 4

- 3 -

MSA

RA

NK

METRO

S

PO

PU

LATIO

N

# O

F H

OSP

ITA

LS

WIT

H E

CM

O A

CC

ES

S

PARTICIPATING MEDICAL CENTERS WITH ECMO ACCESS

AD

ULT

PED

IATRIC

5 Houston-The Woodlands-

Sugar Land, TX MSA 6,892,427 6

MHHS-Center for Advanced Heart Failure at HVI-TMC, Houston, TX ü ü Houston Methodist Hospital ü

University of Texas Medical Branch ü ü Children's Memorial Hermann Hospital ü Texas Children's Hospital ü CHI Baylor ST. Lukes ü

TOTAL 4 4

6 Washington-Arlington-

Alexandria, DC-VA-MD-WV MSA

6,216,589 4

Children's National Medical Center ü MedStar Georgetown University Hospital - ü INOVA Fairfax Medical Campus ü ü George Washington University Hospital ü

TOTAL 2 3

7 Miami-Fort Lauderdale-West Palm Beach, FL

MSA 6,158,824 5

Nicklaus Children's Hospital ü Jackson Health System Holtz Children's Hospital ü Memorial Regional Hospital ü ü University of Miami, Jackson Memorial Hospital (Adult Program) ü ü Joe DiMaggio Children's Hospital ü

TOTAL 2 5

8 Philadelphia-Camden-

Wilmington, PA-NJ-DE-MD MSA

6,096,120 8

Nemours Alfred I. DuPont Hospital for Children ü Children's Hospital of Philadelphia ü St. Christopher's Hospital for Children ü Hospital of the University of Pennsylvania ü ü Penn State Hershey Medical Center ü Lankenau Medical Center - -

St. Luke's University Health Network ü Thomas Jefferson University Hospital Adult ECMO Unit ü

TOTAL 4 4

9 Atlanta-Sandy Springs-

Roswell, GA MSA 5,884,736 4

Children's Healthcare of Atlanta at Egleston ü Piedmont Atlanta Hospital ü - Emory University Hospital ü

Wellstar Kennestone Regional Medical Center - - TOTAL 2 1

10 Boston-Cambridge-Newton, MA-NH MSA

4,836,531 7

Boston Children's Hospital ü Massachusetts General Hospital ü Brigham & Women's Hospital ü Tufts Medical Center and Floating Hospital for Children ü Beth Israel Deaconess Medical Center ü Dartmouth-Hitchcock Medical Center - ü Lahey Hospital & Medical Center ü

TOTAL 4 3

11 Phoenix-Mesa-Scottsdale,

AZ MSA 4,737,270 5

Phoenix Children's Hospital ü Mayo Clinic Hospital - Arizona - - Banner University Medical Center - Phoenix ü St. Joseph's Hospital and Medical Center - Adult Program ü

Cardon Children's Medical Center ü TOTAL 2 2

12 San Francisco-Oakland-

Hayward, CA MSA 4,727,357 3

UCSF Medical Center ü

UCSF Benioff Children's Hospital Oakland ü

UCSF Benioff Children's Hospital ü TOTAL 1 2

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MSA

RA

NK

METRO

S

PO

PU

LATIO

N

# O

F H

OSP

ITA

LS

WIT

H E

CM

O A

CC

ES

S

PARTICIPATING MEDICAL CENTERS WITH ECMO ACCESS

AD

ULT

PED

IATRIC

13 Riverside-San Bernardino-

Ontario, CA MSA 4,580,670 2

San Antonio Regional Hospital ü ü Loma Linda Children's Hospital ü

TOTAL 1 2

14 Detroit-Warren-Dearborn,

MI MSA 4,313,002 3

Children's Hospital of Michigan ü Beaumont Health System ü -

Henry Ford Hospital ü - TOTAL 2 1

15 Seattle-Tacoma-Bellevue,

WA MSA 3,867,046 5

Seattle Children's Hospital ü Mary Bridge Children's Hospital ü University of Washington Medical Center ü

Swedish Health Services | Heart & Vascular Institute ü Harborview Medical Center ü

TOTAL 3 2

16 Minneapolis-St. Paul-

Bloomington, MN-WI MSA 3,600,618 4

Children's Hospitals and Clinics of MN ü Abbott Northwestern Hospital - - University of Minnesota - M Health ü ü Hennepin County Medical Center ü ü

TOTAL 2 3

17 San Diego-Carlsbad, CA

MSA 3,337,685 3

Rady Children's Hospital ü Sharp Memorial Hospital ü Scripps La Jolla Hospitals & Clinics ü -

TOTAL 2 1

18 Tampa-St. Petersburg-Clearwater, FL MSA

3,091,399 5

Tampa General Hospital ü ü Johns Hopkins All Childrens Hospital ü Morton Plant Hospital ü Florida Hospital Tampa ü St. Joseph's Hospital - ü

TOTAL 1 5

19 Denver-Aurora-Lakewood,

CO MSA 2,888,227 5

Children's Hospital Colorado ü University of Colorado Hospital ü

Porter Adventist Hospital ü - National Jewish Health/Saint Joseph Hospital SCL Health ü ü The Medical Center of Aurora ü

TOTAL 3 3

20 Baltimore Columbia-Towson, MD MSA

2,808,175 2 Johns Hopkins Hospital ü University of Maryland Medical Center ü ü

TOTAL 1 2

21 St. Louis, MO-IL MSA 2,807,338 3

Cardinal Glennon Children's Medical Center ü St. Louis Children's Hospital ü Mercy Hospital St. Louis ü

TOTAL 1 2

22 Charlotte-Concord-

Gastonia, NC-SC MSA 2,525,305 1

Carolinas Medical Center and Levine Children’s Hospital ü TOTAL 0 1

23 Orlando-Kissimmee-

Sanford, FL MSA 2,509,831 3

Florida Hospital ü ü Nemours Children's Hospital ü Arnold Palmer Medical Center ü

TOTAL 1 3

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MSA

RA

NK

METRO

S

PO

PU

LATIO

N

# O

F H

OSP

ITA

LS

WIT

H E

CM

O A

CC

ES

S

PARTICIPATING MEDICAL CENTERS WITH ECMO ACCESS

AD

ULT

PED

IATRIC

24 San Antonio-New Braunfels, TX MSA

2,473,974 4

San Antonio Military Medical Center (SAMMC) ü The Children's Hospital of San Antonio ü Methodist Children's Hospital of South Texas ü University Health System ü

TOTAL 1 3

25 Portland-Vancouver-

Hillsboro, OR-WA MSA 2,453,168 3

Legacy Emanuel Medical Center & Randall Children's Hospital ü Oregon Health & Science University ü Providence ARDS Center ü

TOTAL 2 1

26 Pittsburgh, PA MSA 2,333,367 3

Children's Hospital of Pittsburgh of UPMC ü Allegheny General Hospital ü University of Pittsburgh Medical Center ü

TOTAL 2 1

27 Sacramento–Roseville–Arden-Arcade, CA MSA

2,324,884 2 UC Davis Medical Center - ü Sutter Medical Center Sacramento ü ü

TOTAL 1 2

28 Las Vegas-Henderson-

Paradise, NV MSA 2,204,079 1

Sunrise Hospital & Medical Center ü TOTAL 0 1

29 Cincinnati, OH-KY-IN MSA 2,179,082 3

Cincinnati Children's Hospital Medical Center ü The Christ Hospital - - University of Cincinnati Medical Center ü

TOTAL 1 1

30 Kansas City, MO-KS MSA 2,128,912 3

University of Kansas Hospital ü Children's Mercy Hospital ü Saint Luke's Hospital of Kansas City ü

TOTAL 2 1

A review of the Table identifies only two MSAs among the 30 largest U.S. metros that do not have immediate access within their MSA to an adult ECMO machine: (1) Charlotte, NC, and (2) Las Vegas, NV.

CHARLOTTE, NC

The number 22 ranked MSA in the country, Charlotte-Concord-Gastonia, NC-SC MSA, has immediate access to one pediatric ECMO administering hospital. However, as indicated in Image 1, Charlotte is located near several smaller U.S. metros that provide access to an adult ECMO machine. Residents in Charlotte have access to life-saving ECMO technology via five regional hospitals. The closest, Wake Forest Baptist Health, is only 83 miles away from Charlotte’s pediatric ECMO administering hospital, Carolina’s Medical Center and Levine Children’s Hospital.

LAS VEGAS, NV

The number 28 ranked MSA in the country, Las Vegas-Henderson-Paradise, NV MSA, has immediate access to one pediatric ECMO administering hospital. Las Vegas, however, remains a geographic outlier, with the nearest adult ECMO medical equipment found in the Los Angeles or Phoenix metros. As shown in Image 2, Las Vegas has no nearby MSAs with adult ECMO access, as is the case for Charlotte. The nearest adult ECMO access to Las Vegas is found in the Riverside-San Bernardino-Ontario, CA MSA via the San Antonio Regional Hospital, at a distance of 232 miles from Las Vegas’s pediatric ECMO administering hospital, Sunrise Hospital and Medical Center. Adults in Las Vegas who require life-saving ECMO technology must be airlifted to a distant hospital, outside both the Las Vegas MSA, and larger combined statistical area (CSA).

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Image 1: CHARLOTTE-CONCORD-GASTONIA, NC-SC MSA ADULT ECMO ACCESS

Image 2: LAS VEGAS-HENDERSON-PARADISE, NV MSA ADULT ECMO ACCESS