Potential impacts of a novel integrated extracorporeal-CPR workflow using an interventional radiology and immediate whole-body computed tomography system in the emergency department

Hayashida, Kei; Kinoshita, Takahiro; Miyara, Santiago J.; Becker, Lance B.; Fujimi, Satoshi

doi:10.1186/s12872-020-01332-4

Cited by 9 publications

(11 citation statements)

References 13 publications

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“…We limited the analysis to severe trauma patients without severe TBI since a previous study suggested that the significant effects of the hybrid ER on mortality were identified in exsanguinating patients [7]. As these rooms have been used also for severe TBI patients and nontrauma patients in several tertiary care hospitals [21][22][23], the estimated ICER obtained from the model excluding these patients could be imprecise. However, the hybrid ER system is expected to be cost-effective even if we include these patients in the analysis as the investment costs and the depreciation period will not change; the estimated ICER was already lower than the willingnessto-pay threshold under the conservative assumption that this room was annually used for only 68 severe trauma patients without severe TBI.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Kinoshita

Moriwaki²,

Hanaki

et al. 2021

World J Emerg Surg

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Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Kinoshita

Moriwaki²,

Hanaki

et al. 2021

World J Emerg Surg

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“…In the present study, approximately 10% of institutions had the so‐called hybrid ER. Several studies on ECPR in hybrid ER have been recently reported 8,10 . This system has the possibility of seamless ECPR from ECMO induction to CAG, followed by percutaneous coronary intervention without any patient transfer 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies on ECPR in hybrid ER have been recently reported 8,10 . This system has the possibility of seamless ECPR from ECMO induction to CAG, followed by percutaneous coronary intervention without any patient transfer 10 . Regarding the historical rate of ECPR, more than one‐third of institutions carried out ECPR on 10–19 patients/year, which was higher than that of the former study with 40% of institutions having 0–1 patients/year in the USA in 2016 3 .…”

Section: Discussionmentioning

confidence: 99%

“…8,10 This system has the possibility of seamless ECPR from ECMO induction to CAG, followed by percutaneous coronary intervention without any patient transfer. 10 Regarding the historical rate of ECPR, more than one-third of institutions carried out ECPR on 10-19 patients/year, which was higher than that of the former study with 40% of institutions having 0-1 patients/year in the USA in 2016. 3 Recently, excellent data regarding the effectiveness of ECPR for OHCA patients has been reported, 11 and ECPR will continue to be provided in institutions around the world.…”

Section: Demographics Of Institutionsmentioning

confidence: 99%

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Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan

Hifumi

Inoue

Takiguchi

et al. 2021

Acute Medicine & Surgery

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A lack of known guidelines for the provision of extracorporeal cardiopulmonary resuscitation (ECPR) to patients with out-ofhospital cardiac arrest (OHCA) has led to variability in practice between hospitals even in the same country. Because variability in ECPR practice has not been completely examined, we aimed to describe the variability in ECPR practice in patients with OHCA from the emergency department (ED) to the intensive care units (ICU).Methods: An anonymous online questionnaire to examine variability in ECPR practice was completed in January 2020 by 36 medical institutions who participated in the SAVE-J II study. Institutional demographics, inclusion and exclusion criteria, initial resuscitation management, extracorporeal membrane oxygenation (ECMO) initiation, initial ECMO management, intra-aortic balloon pumping/endotracheal intubation/management during coronary angiography, and computed tomography criteria were recorded. Results:We received responses from all 36 institutions. Four institutions (11.1%) had a hybrid emergency room. Cardiovascular surgery was always involved throughout the entire ECMO process in only 14.7% of institutions; 60% of institutions had formal inclusion criteria and 50% had formal exclusion criteria. In two-thirds of institutions, emergency physicians carried out cannulation. Catheterization room was the leading location of cannulation (48.6%) followed by ED (31.4%). The presence of formal exclusion criteria significantly increased with increasing ECPR volume (P for trend <0.001). Intra-aortic balloon pumping was routinely initiated in only 25% of institutions. Computed tomography was routinely carried out before coronary angiography in 25% of institutions. Conclusions:We described the variability in ECPR practice in patients with OHCA from the ED to the ICU.

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“…[20] We limited the analysis to severe trauma patients without severe TBI since a previous study suggested that the signi cant effects of the hybrid ER on mortality were identi ed in exsanguinating patients. [7] As these rooms have been used also for severe TBI patients and non-trauma patients in several tertiary care hospitals [21][22][23], the estimated ICER obtained from the model excluding these patients could be imprecise. However, the hybrid ER system is expected to be cost-effective even if we include these patients in the analysis as the investment costs and the depreciation period will not change; the estimated ICER was already lower than the willingness-to-pay threshold under the conservative assumption that this room was annually used for only 68 severe trauma patients without severe TBI.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of a Hybrid Emergency Room System for Severe Trauma: A health technology assessment from the perspective of the third-party payer in Japan

Kinoshita

Moriwaki

Hanaki

et al. 2020

Preprint

Self Cite

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Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was <0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

show abstract

Potential impacts of a novel integrated extracorporeal-CPR workflow using an interventional radiology and immediate whole-body computed tomography system in the emergency department

Cited by 9 publications

References 13 publications

Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan

Cost-effectiveness of a Hybrid Emergency Room System for Severe Trauma: A health technology assessment from the perspective of the third-party payer in Japan

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