Pediatric and neonatal extracorporeal life support: current state and continuing evolution

Fallon, Brian P.; Gadepalli, Samir K.; Hirschl, Ronald B.

doi:10.1007/s00383-020-04800-2

Cited by 18 publications

(6 citation statements)

References 175 publications

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“…Awake ECMO, early rehabilitation, or models including step-down units may be key to accomplishing these reductions-facilitated by continued simplification and improved safety profiles of ECMO technologies. 13 Earlier initiation of ECMO therapy has also been suggested as a cost-reducing strategy. 14 The second highest charge contributor was iNO, representing 26% in the CDH group and 14% for those receiving this therapy in the RF group.…”

Section: Discussionmentioning

confidence: 99%

Hospital and Professional Charges and Reimbursement Patterns in Pediatric Extracorporeal Membrane Oxygenation

Berazaluce

Frischer

2022

The American Surgeon

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Background Extracorporeal membrane oxygenation (ECMO) is an expensive therapeutic modality. We sought to identify the main charge contributors to patient bills and analyze their patterns of reimbursement. We additionally sought to evaluate the impact of 2015 Current Procedural Terminology (CPT) code changes in professional billing for pediatric surgeons. Methods A retrospective review of ECMO cases at a standalone quaternary children’s hospital between 2008-2017 was performed. Itemized hospital and professional bills were analyzed. Results Top charges included room rates, nitric oxide, medications, invasive support and monitoring, and laboratory testing. Average reimbursement was ∼60% for hospital and ∼36% for professional bills. CPT code changes in 2015 represented a 65% reduction in RVUs and 46% reduction in professional charges. Medicaid reimbursement for professional billing remained stable at 9%, and commercial reimbursement fell from 70% to 59% during the study period. Conclusions The main drivers of ECMO charges are unrelated to ECMO supplies or surgery. Evidence-based guidelines for ECMO management could make a difference in healthcare expenditure. Modern CPT codes depreciate RVUs and professional charges, compromising revenue. As the infrastructure required to provide this service is costly, diminishing returns may limit access to this therapy.

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Section: Discussionmentioning

confidence: 99%

Hospital and Professional Charges and Reimbursement Patterns in Pediatric Extracorporeal Membrane Oxygenation

Berazaluce

Frischer

2022

The American Surgeon

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“…Embora a ECMO proporcione muitos benefícios no tratamento de pacientes pediátricos sob cuidados intensivos em estado crítico, o fato de possuir muitos conectores e pontos de acesso no circuito, eleva o risco de ocorrer estagnação do sangue e à formação de coágulos, bem como da ruptura ou desconexão acidental (FALLON;GADEPALLI;HIRSCHL, 2021). componentes não biológicos do circuito provocam ativação do sistema de compressão e o consumo e degradação de fatores hemostáticos.…”

Section: Introductionunclassified

“…Médico como membro de uma equipe multidisciplinar Serão necessários conhecimento e experiência profundos deste sistema ao aplicá-lo em neonatos, crianças ou pacientes adultos. Isso ocorre porque existe um alto risco de complicações nesse procedimento (MARATTA et al, 2020;FALLON;GADEPALLI;HIRSCHL, 2021)…”

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Os Principais Fatores Da Ecmo Na Uti Pediátrica

Dumont,

Nascimento,

Leal

et al. 2024

Braz. J. Implantol. Health Sci.

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Embora a Oxigenação por Membrana Extracorpórea (ECMO) proporcione muitos benefícios no tratamento de pacientes pediátricos sob cuidados intensivos em estado crítico, o fato de possuir muitos conectores e pontos de acesso no circuito não encontra-se isenta de riscos. Em vista disso, objetivou-se investigar as complicações que encontram-se suscetíveis os pacientes pediátricos em uso da ECMO na Unidade de Terapia Intensiva Pediátrica e as respectivas intervenções para a recuperação do estado de saúde. Para tanto, realizou-se uma revisão narrativa da literatura nas bases de dados LILACS, MEDLINE e SCIELO, no período de 2018-2023. Com os resultados obtidos em pesquisa, evidencia-se um grande interesse na Medicina Intensiva em melhorar a abordagem do paciente pediátrico submetido à ECMO, pelo risco de complicações como, por exemplo, presença e/ou formação de trombos, embolia gasosa e/ou falha do oxigenador durante a execução da técnica. Esses eventos estão associados a interações do sangue com superfícies artificiais do circuito e alterações no padrão de fluxo sanguíneo, além de um maior número de eventos adversos relacionados à duração prolongada do tratamento, mas que podem ser retidos priorizando o monitoramento em dois itinerários de tratamento.ação: técnica de monitoramento, incluindo manutenção da cânula, fluxo do oxigenador, rotações do oxigenador, pressões do oxigenador, temperatura do circuito, índice de coagulação, avaliação gasométrica no oxigenador; e monitoramento do paciente por meio da avaliação de parâmetros vitais e glicemia capilar, sistema neurológico, diurese e perda sanguínea, posicionamento, bem como parâmetros ventilatórios e gasometria arterial

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“…9 More recently, the "awake ECLS, " namely, early extubation in pediatric patients while on ECMO treatment, has become a standard of care aimed at minimizing sedation requirements and expediting recovery. 10 Our aim is to report an update of our experience with pediatric ECMO cases at the University Hospital Center Zagreb over the past 11 years 6,[11][12] Also, the aim is to identify variables associated with outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…9 More recently, the “awake ECLS,” namely, early extubation in pediatric patients while on ECMO treatment, has become a standard of care aimed at minimizing sedation requirements and expediting recovery. 10…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in children: An update of a single tertiary center 11-Year experience from Croatia

et al. 2022

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Introduction: Extracorporeal membrane oxygenation (ECMO) is an important treatment option for organ support in respiratory insufficiency, cardiac failure, or as an advanced tool for cardiopulmonary resuscitation. Reports on pediatric ECMO use in our region are lacking. Methods: This study is a retrospective review of all pediatric cases that underwent a veno-arterial (VA) or veno-venous (VV) ECMO protocol between November 2009 and August 2020 at the Department of Pediatrics, University Hospital Center Zagreb, Croatia. Results: Fifty-two ECMO runs identified over the period; data were complete for 45 cases, of which 23 (51%) were female, and median age was 8 months. Thirty-eight (84%) patients were treated using the VA-and 7 (16%) using VV-ECMO. The overall survival rate was 51%. Circulatory failure was the most common indication for ECMO ( N = 38, 84%), and in 17 patients ECMO was started after cardiopulmonary resuscitation (E-CPR). Among survivors, 74% had no or minor neurological sequelae. Variables associated with poor outcome were renal failure with renal replacement therapy ( p < .001) and intracranial injury ( p < .001). Conclusion Overall survival rate in our cohort is comparable to the data published in the literature. The use of hemodialysis was shown to be associated with higher mortality. High rates of full neurological recovery among survivors are a strong case for further ECMO program development in our institution.

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Pediatric and neonatal extracorporeal life support: current state and continuing evolution

Cited by 18 publications

References 175 publications

Hospital and Professional Charges and Reimbursement Patterns in Pediatric Extracorporeal Membrane Oxygenation

Hospital and Professional Charges and Reimbursement Patterns in Pediatric Extracorporeal Membrane Oxygenation

Os Principais Fatores Da Ecmo Na Uti Pediátrica

Extracorporeal membrane oxygenation in children: An update of a single tertiary center 11-Year experience from Croatia

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