Medical Resources and Clinical Outcomes for Extracorporeal Membrane Oxygenation Treatment under the Japanese Health Insurance System: A Single-Center Retrospective Observational Study.

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) is a resource-intensive life support therapy associated with high complication rates. Blood products are a major cost driver, yet their impact on outcomes under the Japanese health insurance system remains unclear. This study investigated the association between transfusion burden and clinical outcomes in ECMO patients.

METHODS

We retrospectively analyzed data from 112 adult patients who received ECMO at Nippon Medical School Hospital between 2014 and 2023. Baseline characteristics, laboratory findings, and transfusion volumes of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets were compared in relation to survival and death. Sixty-day mortality was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Predictors of transfusion burden were evaluated with multivariable regression.

RESULTS

Transfusion of FFP (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.15-3.46) and RBCs (HR 2.37, 95%CI 1.14-4.93) were independently associated with increased 60-day mortality, whereas platelet transfusion was not. Nonsurvivors required significantly larger volumes of all blood products. Transfusion burden was primarily determined by longer ECMO duration and lower fibrinogen levels. Blood products accounted for 56.1% of drug-related expenditures during ECMO.

CONCLUSIONS

Transfusion burden was a key determinant of mortality and cost in ECMO patients and was mainly affected by prolonged ECMO duration and low fibrinogen levels. These findings highlight the clinical and economic impact of transfusion practices and underscore the need for prospective multicenter validation to establish evidence-based transfusion strategies in Japan.