The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation – a cost analysis

Abstract

BackgroundTo evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV).MethodsRetrospective ancillary cost analysis of data extracted from a recently published multicentre case–control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system.ResultsIn the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01).ConclusionsAdditional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure

“…For patients with this severity of COPD, who have failed NIV, the ICU length of stay was relatively short at a median of 7 days. 17 It is difficult to make meaningful comments on mortality in this cohort given the size of the study, however it is in keeping with mortality reported in other studies of ECCO 2 R in severe COPD exacerbation.…”

Extracorporeal carbon dioxide removal for lowering the risk of mechanical ventilation: research questions and clinical potential for the future

“…2 In addition, preliminary, retrospective data suggest there may be economic benefit in using ECCO 2 R to avoid invasive mechanical ventilation, because it reduces intensive care unit and hospital length of stay. 49 The use of ECCO 2 R for facilitating extubation from invasive mechanical ventilation in hypercapnic COPD patients is another potential indication. In an elegant physiological demonstration, ECCO 2 R reduced respiratory muscle work and carbon dioxide production in intubated patients during weaning.…”

Very low blood flow carbon dioxide removal system is not effective in a chronic obstructive pulmonary disease exacerbation setting

“…In such patients, ECCO 2 R coupled with NIV improves CO 2 washout, normalizes pH, and lowers respiratory rate, dynamic hyperinflation, and intrinsic positive end‐expiratory pressure 1 . Moreover, by avoiding endotracheal intubation, and thus, IMV, it limits adverse effects associated with analgosedation such as hemodynamic instability, difficulty weaning, and critical illness polyneuromyopathy, and may lead to a reduction of overall treatment costs 7 . Furthermore, by decreasing respiratory rates, ECCO 2 R reduces the work of breathing, lowers CO 2 production of the respiratory muscles, and thus, contributes to decreased PaCO 2 8 .…”