open access

Vol 49, No 2 (2017)
Original and clinical articles
Published online: 2017-06-22
Submitted: 2016-11-05
Accepted: 2017-03-18
Get Citation

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Sylweriusz Kosiński, Tomasz Darocha, Anna Jarosz, Aleksandra Czerw, Paweł Podsiadło, Tomasz Sanak, Robert Gałązkowski, Jacek Piątek, Janusz Konstanty-Kalandyk, Mirosław Ziętkiewicz, Krzysztof Kusza, Łukasz J. Krzych, Rafał Drwiła
DOI: 10.5603/AIT.2017.0029
·
Pubmed: 28643322
·
Anaesthesiol Intensive Ther 2017;49(2):106-109.

open access

Vol 49, No 2 (2017)
Original and clinical articles
Published online: 2017-06-22
Submitted: 2016-11-05
Accepted: 2017-03-18

Abstract

BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland.

METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract.

RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss.

CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.

Abstract

BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland.

METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract.

RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss.

CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.

Get Citation

Keywords

membrane oxygenation; severe hypothermia; funding

About this article
Title

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 2 (2017)

Pages

106-109

Published online

2017-06-22

DOI

10.5603/AIT.2017.0029

Pubmed

28643322

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(2):106-109.

Keywords

membrane oxygenation
severe hypothermia
funding

Authors

Sylweriusz Kosiński
Tomasz Darocha
Anna Jarosz
Aleksandra Czerw
Paweł Podsiadło
Tomasz Sanak
Robert Gałązkowski
Jacek Piątek
Janusz Konstanty-Kalandyk
Mirosław Ziętkiewicz
Krzysztof Kusza
Łukasz J. Krzych
Rafał Drwiła

References (12)
  1. Brown DJA, Brugger H, Boyd J, et al. Accidental hypothermia. N Engl J Med. 2012; 367(20): 1930–1938.
  2. Central Statistical Office of Poland (2015) Demographic base.
  3. Kosiński S, Darocha T, Gałązkowski R, et al. Accidental hypothermia in Poland – estimation of prevalence, diagnostic methods and treatment. Scand J Trauma Resusc Emerg Med. 2015; 23: 13.
  4. Truhlář A, Deakin CD, Soar J, et al. Cardiac arrest in special circumstances section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015; 95: 148–201.
  5. Wróblewska W. Zgony możliwe do uniknięcia – opis koncepcji oraz wyniki analizy dla Polski. Studia Demograficzne. 2012; 161(1).
  6. Darocha T, Kosiński S, Jarosz A, et al. Severe Accidental Hypothermia Center. Eur J Emerg Med. 2015; 22(4): 288–291.
  7. Lango R, Szkulmowski Z, Maciejewski D, et al. Protokół zastosowania pozaustrojowej oksygenacji krwi (extracorporeal membrane oxygenation - ECMO) w leczeniu ostrej niewydolności oddechowej Zalecenia i wytyczne Nadzoru Krajowego oraz Konsultanta Krajowego w dziedzinie Anestezjologii i Intensywnej Terapii. Anestezjol Intens Ter. 2009; 41: 253–258.
  8. Ładny JR, Kusza K, Knapik P. Zalecenie dla personelu szpitalnych oddziałów ratunkowych/izb przyjęć. http://www.hipotermia.edu.pl/.
  9. Dunne B, Christou E, Duff O, et al. Extracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: a systematic review of the literature. Heart Lung Circ. 2014; 23(11): 1029–1035.
  10. Ruttmann E, Weissenbacher A, Ulmer H, et al. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg. 2007; 134(3): 594–600.
  11. Debaty G, Moustapha I, Bouzat P, et al. Outcome after severe accidental hypothermia in the French Alps: A 10-year review. Resuscitation. 2015; 93: 118–123.
  12. Darocha T, Kosiński S, Jarosz A, et al. The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming. Scand J Trauma Resusc Emerg Med. 2016; 24: 85.

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