-Original-

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

Hiroshi Mase^1,2, Yuki Genda^1,2, Shunichi Yasuda^2,3, Takuya Nishino⁴, Hiroki Yamaguchi³ and Masashi Ishikawa¹

¹Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
²Department of Surgical Intensive Care, Nippon Medical School Hospital, Tokyo, Japan
³Department of Hematology, Nippon Medical School, Tokyo, Japan
⁴Department of Health Care Administration, Nippon Medical School, Tokyo, Japan

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.

J Nippon Med Sch 2026; 93: 259-268

Keywords
ECMO, blood product, cost

Correspondence to
Hiroshi Mase
hiroshi-m@nms.ac.jp

Received, September 19, 2025
Accepted, March 19, 2026