52: Doing more with less - A cost-effective strategy for the ECMO program

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is vital for severe cardiac and respiratory failure, yet high costs limit its accessibility, especially in low- and middle-income countries. Our institute has developed cost-effective strategies using custom-made and repurposed ECMO components. By modifying standard CPB (cardiopulmonary bypass) systems, we created a solution for rapid initiation of ECMO support during acute cardiovascular collapse that can also be adapted for full CPB support1. Methods: Cost remains a key barrier to ECMO initiation, especially when families need time to arrange funds. We address this by using heparin-coated, custom-made circuits with CPB oxygenators, pre-assembled for quick setup within five minutes. In urgent cases, particularly for extracorporeal cardiopulmonary resuscitation (ECPR), ECMO is initiated with CPB circuits, providing immediate support while finances are arranged. Over 24 hours, we assess clinical parameters—such as lactate clearance, hemodynamics, urine output, and neurological response—to decide on ECMO continuation. This approach reduces initiation costs to 20% of standard expenses. Results: Our protocol has effectively revived patients with ventilation failure and hypoxic cardiac arrest, including a case of massive airway hemorrhage where ECPR stabilized the patient, later transitioning to conventional ECMO. Multiple cases of myocardial infarction and circulatory collapse in emergency and ICU settings were managed on veno-arterial (VA) ECMO, with 60% of patients showing improvement and transitioning to conventional circuits. However, 40% did not improve, likely due to inflammatory responses triggered by blood contact with artificial surfaces2. Post-cardiotomy patients requiring brief support were also successfully managed with this approach. Conclusions: This method provides accessible, effective ECMO support in acute cases, proving safe and efficient for up to 48 hours without circuit complications, though anticoagulation levels are maintained at higher targets. While CPB supports patients briefly, ECMO enables extended support for 3–10 days3, enhancing treatment flexibility.