Economics and Ethics of ECMO for Cardiac Arrest pdf/L… · RN pay differential is $28.45/hr for...
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Economics and Ethics of ECMO for Cardiac Arrest Ashish S. Shah, MD Professor of Surgery Vanderbilt University Medical Center
Transcript of Economics and Ethics of ECMO for Cardiac Arrest pdf/L… · RN pay differential is $28.45/hr for...
Economics and Ethics of ECMO for Cardiac Arrest
Ashish S. Shah, MD
Professor of Surgery
Vanderbilt University Medical Center
E- CPROut of hospital Cardiac Arrest
In hospital cardiac arrest
Trauma
Out of Hospital Arrest
Out of Hospital Arrest
n= 695,000
Out of Hospital Arrest
Out of Hospital Arrest
Is ECPR and Public Health Problem?
In Hosp Arrest
Long Term survival Poor
19% vs 13% at 1 year
The eCPR ConstituenciesEmergency Medicine
EMS
ECMO Attendings
Cardiologists
Cardiac Surgeons
Perfusion services
Respiratory Services
Who Cannulates and Where?
ED
Cath Lab
OR
Target/Walmart
How to pay for it
6 Intensivist and I do not know the total salaries for the intensivist
11 specialist (10.5 FTEs) – July 2017 through end of December 2017, we have paid $161,554 in total salaries for ECMO
Perfusionists– July 2017 through end of December 2017, we have paid $228,572 in total salaries for ECMO
RN pay differential is $28.45/hr for about 3800 hours would be $108,110.
The only capital equipment request we have at the moment is for the Cardiohelp. The total request is $402,723.78
ICU bed day cost is $10,195 per day
Infrastructure
Infrastructure
2 nurses per ECMO patient, 1 perfusionist in house whenever a patient is on, Rounding team CV Surg, Intensivist, HF Cardiologist if VA ECMO, nutrition, pharmacy etc.
perfusionists like staying in house - the get a bonus of $125/hr while in house.
Infrastructure
115 ecmo in 112 pts 40 VV.
ICU rn 1:1 . Ecmo specialist 1:3-1:4. ICU team. Surgeon.
Ecmo specialist RT or RN. ICU rn plus icuRT responsible for pt.
One perfusionist in house responsible forecmo backup. Cannot also do cases.
Reimbursement/ Margin
Heart Transplant $100k
CABG $30k
Uninsured ECMO -$250,000
ICU bed or OR case lost because of ECMO patients
800 OHCA
250,000
Fundamental Questions and Gaps
When to stop
Termination of resuscitationViable bridging strategies
Financial and resource burdenDisability
ECMO for out of hospital cardiac arrest
Suicide
IVDU
Jane Doe
To Cannulate or Not?
To Cannulate or Not?
Is this a public expectation?
Is recovery a realistic expectation?
How do we define successful outcome?
How much disability should the public expect?
Who should bear the cost of the uninsured?
When to stop?
Is time arbitrary?
Will we know it when we see it?
Defining futility in ECMO
