74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR

Have you ever pondered whether all the work over ECPR was worth it?  Even if you did save a few patients, does this really make sense from a societal standpoint?  Am I giving up my life on a project where my efforts could be better elsewhere?  Then this episode is for you (and me).  This month I talk with Melissa Barnes and Ryan Coute about the economics of cardiac arrest and specifically ECPR.  Ryan has just published a great paper in Resuscitation on the costs on OHCA.  We will talk with Ryan and Melissa Barnes, ECMO manager at Sharp Memorial Hospital about benefits and costs to society of OHCA and ECMO.  I learned several pearls from Ryan’s paper as well as a paper by Grosse that Ryan references.  Below are the links to both papers with a couple graphs to try to wrap your head around.

Coute

Image

 

Coute

Economic loss of productivity of OHCA

Grosse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688510/

 

 


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Comments

  1. HiZack!!

    (it’s tom fiero, from merced, ca. ( remember the sting ray emergency a few months ago at Coronado Beach, and your great advice?)

    this was an extraordinarily helpful, thoughtful, concise discussion on the monetary benefits of ECPR, as well as consideration of VV vs VA and long term (?up to 6 months ! in the ICU on pump) ECMO, particularly for our Covid population. I guess one must realize that the monies available for healthcare are not infinite, and thus, we must at least consider the economic impact on society.

    A separate conversation, Zack, as you know , is the actual and real impact on the individual life saved. I remember clearly, Zack, the early pods on this blog of the many lives saved by ECMO. (eg,”the story of ralph ” (2014 early blog), the multi-drug OD (edecmo 27), the young dying anaphylactic patient (edecmo 31) and pod #37, ED doc Jake was involved in his own son Nate’s ECMO…I spoke to Jake months afterward when he accepted a transfer from me from Merced), and many many more individuals, both in your shop and elsewhere on the planet.

    so …there is the economic advantage to ED-ECPR for OHCA and near arrest , and perhaps also for the more prolonged ECMO up in the ICU, that we were discussing today; but also the incredible human ethical “advantage” to society with each life that you, and others like you, have saved. lives that are much much more than an economic value as you well know.

    thank you and Ryan and Melissa for this excellent pod.

    incidentally, we tried that remedy you suggested to me when I called you emergently that day, for the sting ray wound.
    we got a bunch people to stand around the patient and ….
    well, it worked.

    tom
    merced ca, Mercy Hospital ED

    • Thx Tom!! I agree the feelings of saving that “unsaveable” are so profound that it’s sometimes hard to even consider the economic aspects. System wide though it’s pretty important.
      Zack
      Ps I hope it was a jellyfish otherwise it was just some kind of awkward:)

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