Outcomes in Cardiogenic Shock Patients with Extracorporeal Membrane Oxygenation Use: A Matched Cohort Study in Hospitals across the United States

Sibai, Rayan El; Bachir, Rana; Sayed, Mazen El

doi:10.1155/2018/2428648

Cited by 22 publications

(13 citation statements)

References 35 publications

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“…Hence, selected patients may benefit from vv-ECMO by avoiding an additional ventilator-associated lung injury (VALI) [ 12 , 13 ]. In the cases of cardiogenic shock and va-ECMO use, the available information on patient benefits is likewise scarce and a subject of debate [ 14 , 15 , 16 ]. Multiple studies strived to evaluate the potential benefit of ECMO support, but due to methodological issues, its efficacy remains controversial [ 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Treml

Breitkopf

Bukumirić

et al. 2022

JCM

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Background: Extracorporeal membrane oxygenation (ECMO) is a specialised life support modality for patients with refractory cardiac or respiratory failure. Multiple studies strived to evaluate the benefits of ECMO support, but its efficacy remains controversial with still inconsistent and sparse information. Methods: This retrospective analysis included patients with ECMO support, admitted between January 2010 and December 2019 at a tertiary university ECMO referral centre in Austria. The primary endpoint of the study was overall all-cause three-month mortality with risk factors and predictors of mortality. Secondary endpoints covered the analysis of demographic and clinical characteristics of patients needing ECMO, including incidence and type of adverse events during support. Results: In total, 358 patients fulfilled inclusion criteria and received ECMO support due to cardiogenic shock (258, 72%), respiratory failure (88, 25%) or hypothermia (12, 3%). In total, 41% (145) of patients died within the first three months, with the median time to death of 9 (1–87) days. The multivariate analysis identified hypothermia (HR 3.8, p < 0.001), the Simplified Acute Physiology Score III (HR 1.0, p < 0.001), ECMO initiation on weekends (HR 1.6, p = 0.016) and haemorrhage during ECMO support (HR 1.7, p = 0.001) as factors with higher risk for mortality. Finally, the most frequent adverse event was haemorrhage (160, 45%) followed by thrombosis. Conclusions: ECMO is an invasive advanced support system with a high risk of complications. Nevertheless, well-selected patients can be successfully rescued from life-threatening conditions by prolonging the therapeutic window to either solve the underlying problem or install a long-term assist device. Hypothermia, disease severity, initiation on weekends and haemorrhage during ECMO support increase the risk for mortality. In the case of decision making in a setting of limited (ICU) resources, the reported risk factors for mortality may be contemplable, especially when judging a possible ECMO support termination.

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Section: Introductionmentioning

confidence: 99%

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Treml

Breitkopf

Bukumirić

et al. 2022

JCM

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“…26,27 Previous investigators have highlighted the ease of use of Impella 5.0 28 as well as conversely the logistical challenges, complexity and high levels of medical resource use associated with the use of VA-ECMO. 14,24 Additionally, when interpreting the findings of the analysis presented here it is important to note that although the use of Impella 5.0 may be associated with cost savings there are instances where the use of VA-ECMO may represent a more appropriate intervention. For example, VA-ECMO is the preferred treatment modality for patients with refractory cardiac arrest, multiorgan failure or respiratory failure.…”

Section: Discussionmentioning

confidence: 97%

“…In one US-based analysis in CS, patients managed with ECMO had mean total hospital charges of USD 580,066 per patient, compared with USD 156,437 per patient without ECMO. 24 The magnitude of the management costs for patients with CS when all direct costs are captured therefore underscores the cost-saving potential associated with the introduction of Impella 5.0 into clinical practice in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

Guyader¹,

Pernot²,

Delmas³

et al. 2021

CEOR

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Aim: Cardiogenic shock (CS), if not diagnosed and treated rapidly, can lead to irreversible multiorgan damage and death. An economic analysis was conducted to determine the budget impact of the introduction of Impella 5.0 ® , a mechanical circulatory support (MCS) device that directly unloads the left ventricle, into clinical practice in patients with left ventricular CS in France. Methods: A budget impact model was developed to compare the cost of Impella 5.0 with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) from the perspective of the French national healthcare insurer. Costs associated with Impella 5.0, plus complicationrelated costs for VA-ECMO or Impella 5.0 from 2019 were included and clinical input data relating to complication rates and time spent on device were sourced from published literature. Extensive scenario and one-way deterministic sensitivity analyses were performed to explore the influence of uncertainty around key input parameters. Results: Over a time horizon of 5 years, the introduction of Impella 5.0 was associated with cumulative savings of EUR 4.3 million. The results were driven by the lower risk of devicerelated complications associated with Impella 5.0. Savings were apparent from Year 1 onwards, with savings in excess of EUR 375,000 projected in Year 1 alone. On a perpatient level, in Year 1, estimated savings with the introduction of Impella 5.0 totaled EUR 616 per patient. Sensitivity analyses showed that the findings of the analysis were robust. Conclusion:The Impella 5.0 device was associated with cumulative cost savings in excess of EUR 4 million over a 5-year period compared with current practice. Projected savings were driven by a lower rate of device-related complications with Impella 5.0 compared with VA-ECMO.

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“…The scope of the present analysis, which took a budget impact approach, meant that pertinent ease-of-use benefits with Impella CP were likely not captured [ 37 , 38 ]. Ease of use with Impella CP is particularly evident when compared with the logistical challenges, complexity, and high levels of medical resource use associated with VA-ECMO [ 20 , 39 ]. The distinction between secondary and tertiary treatment centers in the modeling analysis was important to capture the advantage of Impella CP as an interventional cardiology procedure.…”

Section: Discussionmentioning

confidence: 99%

Budget Impact Analysis of Impella CP® Utilization in the Management of Cardiogenic Shock in France: A Health Economic Analysis

et al. 2022

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Introduction: Early detection and treatment of cardiogenic shock (CS) is crucial to avoid irreparable multiorgan damage and mortality. Impella CP Ò is a novel temporary mechanical circulatory support (MCS) device associated with greater hemodynamic support and significantly fewer device-related complications compared with other MCS devices, e.g., intra-aortic balloon pumps (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). The present study evaluated the budget impact of introducing Impella CP versus IABP and VA-ECMO in patients with CS following an acute myocardial infarction (MI) in France. Methods: A budget impact model was developed to compare the cost of introducing Impella CP with continuing IABP and VA-ECMO treatment from a Mandatory Health Insurance (MHI) perspective in France over a 5-year time horizon, with 700 patients with refractory CS assumed to be eligible for treatment per year. Costs associated with Impella CP and device-related complications for all interventions were captured and clinical input data were based on published sources. Scenario analyses were performed around key parameters. Results: Introducing Impella CP was associated with cumulative cost savings of EUR 2.7 million over 5 years, versus continuing current clinical practice with IABP and VA-ECMO. Cost savings were achieved in every year of the analysis and driven by the lower incidence of device-related complications with Impella CP, with estimated 5-year cost savings of EUR 22.4 million due to avoidance of complications. Total cost savings of more than EUR 250,000 were projected in the first year of the analysis, which increased as the market share of Impella CP was increased. Scenario analyses indicated that the findings of the analysis were robust. Conclusion: Treatment with Impella CP in adult patients aged less than 75 years in a state of refractory CS following an MI was projected to lead to substantial cost savings from an MHI

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Outcomes in Cardiogenic Shock Patients with Extracorporeal Membrane Oxygenation Use: A Matched Cohort Study in Hospitals across the United States

Cited by 22 publications

References 35 publications

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France

Budget Impact Analysis of Impella CP® Utilization in the Management of Cardiogenic Shock in France: A Health Economic Analysis

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