Financial and clinical outcomes of extracorporeal mechanical support

Abstract

In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO.

Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

“…The increased use of LVADs and extracorporal mechanical support (ECMO) has prompted interest in determining which groups of patients are more prone to increased perioperative complications and may not benefit from this more aggressive support. 13 While frailty has been identified as a potential risk factor for poor long-term survival, frailty alone may not identify patients at increased risk for adverse outcomes following cardiac surgical procedures. 14 In addition, the effects of obesity have also been studied in LVAD patients, but BMI itself may not be an independent predictor of overall survival.…”

Should patients with hypoalbuminemia undergo LVAD implantation?

“…Furthermore, patients with hypoalbuminemia undergoing LVAD implantation may not recover sufficiently to be considered candidates for heart transplantation. In view of the increasing costs associated with LVAD therapy, 3 While deceased preoperative serum albumin levels are a marker for increased perioperative morbidity and decreased short-and long-term survival following LVAD implantation, the data from this study suggest that serum albumin alone cannot be used to exclude patients for LVAD support who may be potential candidates for heart transplantation. These patients will require more aggressive perioperative nutritional supplementation and continued therapy for underlying co-morbidities in addition to LVAD support.…”

“…Furthermore, patients with hypoalbuminemia undergoing LVAD implantation may not recover sufficiently to be considered candidates for heart transplantation. In view of the increasing costs associated with LVAD therapy, the known increased morbidity and mortality in patients with hypoalbuminemia, and the uncertainty of the option for heart transplantation, should patients with moderate and severe serum hypoalbuminemia undergo LVAD therapy?…”

Repeat extracorporeal membrane oxygenation support-Are the results better the second time around?

“…As is the case with all ECMO support, underlying co‐morbidities, the indication for ECMO support, and the potential for end organ reversibility will be key factors. ECMO is expensive and costs may be as high as $74 500 per patient during the time of ECMO support . The significant increase in hospital LOS will only add to this cost.…”