Extracorporeal cardiopulmonary resuscitation in Medicare recipients.

Objective: The use of extracorporeal cardiopulmonary resuscitation (ECPR) in older patients is a controversial practice. The historically high mortality associated with elderly patients who require extracorporeal support frequently dampens the enthusiasm for expending limited, cost-intensive resources on patients of advanced age. We evaluated outcomes in Medicare patients who had suffered sudden acute cardiac arrest and received extracorporeal support. Methods: We used the United States Medicare Inpatient Analytical Files (2018-2023) to evaluate beneficiaries with cardiac arrest who were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO). International Classification of Diseases, Tenth Revision codes were used to define comorbidities and frailty using validated metrics. Results: Of the 5810 Medicare beneficiaries who were placed on VA-ECMO, 1174 experienced cardiac arrest during the same admission and were categorized as the "ECPR cohort." Their mean Charlson Comorbidity Index score was 2.66 ± 1.36. Approximately one-third had a history of diabetes, liver disease, and chronic renal failure; 52.9% had coronary artery disease, and 65.4% had heart failure. Mortality during hospitalization was 63.8%. Age-stratified 5-year mortality was 69.8% in patients age <70, 78.0% in those age 71% to 80%, and 86.8% in those age >80 years. Conditional on surviving to discharge, mortality was ∼10% at both 1 year and 5 years. Conclusions: The use of ECPR in Medicare recipients is characterized by high mortality, which further increases with age. This real-world report may help guide the complex clinical decision making in the resuscitation of elderly patients who suffer cardiac arrest.