Purpose: Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients to provide cardiac and/or respiratory support. Despite improvement in technology, experience, and management, the survival rate remains low. In the Extracorporeal Life Support Organization (ELSO) registry only 43% of adult ECMO patients survived to discharge, though readmission rates and reasons for readmission are not captured. These data are valuable to determine discharge planning and education for ECMO patients. This study retrospectively assessed readmission rates, reason for readmission, and outcomes within the first year of hospital discharge for survivors of ECMO therapy at an urban medical center. Methods: A retrospective chart review from patients who survived ECMO to discharge between January 2009 and July 2014 was conducted. ECMO duration, type (Veno-Arterial (VA)/ Veno-Venous (VV)), date of discharge, rate and reason for readmission, and mortality were recorded. Descriptive statistics were used for data analysis. Results: Complete data were available for 48 patients; 32 were recipients of VA ECMO, 13 of VV ECMO, and 3 were converted from VA to VV. Seventy-one percent (n= 34) of patients were readmitted within the first year of discharge (mean number of readmissions: 2.7; range 1-8). Eighty percent of readmissions were unplanned, and the majority of patients were readmitted with pulmonary illness (37%). Fifty-four percent (n= 26) of patients had an unplanned first readmission, mean number of days to readmission post-discharge was 84.59 (range 1-342 days). Eighty-one percent (n= 39) of patients survived one year post-discharge. Four patients died between discharge and 3 months; 1 patient died between 3 and 6 months; and 4 patients died between 6 and 12 months post-discharge. Conclusion: Eighty-one percent of the patients in our cohort who survived ECMO to discharge were still alive one year post-discharge. Several patients had unplanned readmissions within the first year. Findings suggest the need for careful monitoring and follow up post-discharge, particularly regarding pulmonary illness, due to increased risk for morbidity and readmission. Discharge education provided to patients and their families should highlight the increased risk for development of illness post-discharge, and the need for efficient follow up, should symptoms occur.

Ventricular assist device (VAD) therapy is increasingly utilized to support patients in end-stage heart failure. However, VAD programs are resource intensive and demand active monitoring to ensure long-term sustainability. The purpose of this study was to analyze total cost trends of the VAD program at our academic medical center. Retrospective analysis of University of California - Los Angeles's VAD program between 2013 and 2014 was performed. Total in-hospital costs from the date of VAD surgery admission were queried and normalized to a z score. Multivariable linear regression analysis with step-wise elimination was used to model total costs. Overall, 42 patients received a VAD during the study period, with 19 (45%) receiving biventricular support. On univariate analysis, high body mass index, biventricular support, time between VAD implantation and discharge, and total length of hospital stay were correlated with higher costs (all p < 0.02). On multivariable analysis, time between VAD implantation and discharge and biventricular support remained significantly related to total costs (overall R = 0.831, p < 0.001). The time between VAD implantation and discharge and the use of biventricular support were the most predictive factors of total cost in our VAD population. Reducing hospital stay post-VAD implantation is important in minimizing the cost of VAD care.

Background: Aspiration pneumonia is a rare but serious complication that carries significant morbidity following surgery. This study was undertaken to identify pre-operative and operative risk factors and develop a predictive model for aspiration pneumonia in cardiac surgery patients.