Kosiński Sylweriusz, Darocha Tomasz, Jarosz Anna, Czerw Aleksandra, Podsiadło Paweł, Sanak Tomasz, Gałązkowski Robert, Piątek Jacek, Konstanty-Kalandyk Janusz, Ziętkiewicz Mirosław, Kusza Krzysztof, Krzych Łukasz J, Drwiła Rafał
Department of Anaesthesiology and Intensive Care with Cardiac Monitoring Independent Public Central Clinical Hospital No 7 of the Silesian Medical University in Katowice, Leszek Giec Upper-Silesian Medical Centre, Katowice, Poland; Chair and Department of Anaesthesiology and Intensive Care, Medical University of Silesia in Katowice, Poland; Polish Air Rescue, Warsaw, Poland.
Anaesthesiol Intensive Ther. 2017;49(2):106-109. doi: 10.5603/AIT.2017.0029.
Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland.
We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract.
In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss.
Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.
严重意外低温被定义为核心体温低于28摄氏度。在过去几年中，意外低温及伴随的心搏骤停问题已得到广泛讨论，欧洲复苏委员会（ERC）指南强调了体外复温（ECR）在治疗严重低温患者中的重要性。本研究旨在评估在波兰克拉科夫严重意外低温中心接受治疗的患者，使用VA-ECMO进行体外复温及在重症监护病房进一步治疗的实际成本。
我们对31例接受VA ECMO治疗的III-IV期（瑞士分期）低温成年患者进行了经济分析。其中29例患者在重症监护病房进一步接受治疗。实际治疗成本根据当前药物、设备和敷料价格进行评估。然后将约翰·保罗二世医院产生的费用与根据当前财务合同评估的国家医疗服务体系（NHS）资金进行核对。
在大多数情况下，实际治疗成本高于所获得的资金，每位患者约高出10000波兰兹罗提。只有4例（14%）患者实现了财务收支平衡；其他25例（86%）出现了财务亏损。
所进行的分析清楚表明，开展体外复温的医院可能会因实施国际指南推荐的有效治疗而遭受财务损失。自2017年1月起实施的新的NHS资金政策可避免此类损失，这将鼓励医院采用这种昂贵但有效的治疗方法。
