Extracorporeal membrane oxygenation: how, where, who and at what cost?

This dissertation focuses on the use of extracorporeal membrane oxygenation (ECMO), a technique that can temporarily take over the function of the heart and/or lungs when these organs fail. ECMO is being used more frequently, for example in severe lung diseases such as COVID-19, or in patients with cardiac arrest who do not recover with conventional resuscitation. This research addresses three key questions: when should ECMO be initiated, where can it best be provided, and at what cost?

The dissertation shows that starting ECMO outside specialized centers, with off-center initiation prior to transport, can be safe if performed by experienced teams. During the COVID-19 pandemic, ECMO also proved to be a valuable addition that improved survival. In contrast, hospital-based ECMO during resuscitation did not demonstrate benefit and was associated with high societal costs. This dissertation contributes to improved patient selection, safer application, and a fairer assessment of costs and benefits within healthcare.