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Economics and ethics of paediatric respiratory extra corporeal life support
M Callaghan1, Y Doyle, B O'Hare
1Our Lady's Children's Hospital, Crumlin, Dublin 12. michaelcallaghan7@hotmail.com
Insights
Establishing a national paediatric Extra Corporeal Membrane Oxygenation (ECMO) centre in Ireland is recommended. This would consolidate cardiac and respiratory support, reducing costs and risks associated with infant transfers for critical care.
Area of Science:
- Cardiology
- Pediatrics
- Respiratory Medicine
Background:
- Our Lady's Children's Hospital, Crumlin (OLCHC) established a paediatric cardiac Extra Corporeal Membrane Oxygenation (ECMO) program in 2005.
- The program has successfully treated 75 patients, primarily post-operative cardiac cases, with outcomes comparable to international standards.
Observation:
- ECMO is highly effective for neonates with severe respiratory failure, including conditions like meconium aspiration and respiratory distress syndrome.
- Ireland currently lacks a dedicated paediatric respiratory ECMO program, necessitating costly international transfers for affected neonates.
- These transfers incur an average cost of €133,000 per infant and pose significant risks and psychosocial burdens to families.
Findings:
- OLCHC possesses the necessary equipment and expertise for respiratory ECMO, similar to its cardiac capabilities.
- The average cost of an ECMO treatment at OLCHC is €65,000, significantly less than international transfer costs.
- There is a compelling case for a unified, national paediatric ECMO center for both cardiac and respiratory support.
Implications:
- Implementing a national paediatric ECMO center could reduce healthcare costs and improve patient outcomes.
- Centralizing services would mitigate the risks and psychosocial impact associated with inter-country transfers of critically ill infants.
- This initiative aligns with the need for comprehensive, specialized paediatric critical care services in Ireland.
Abstract:
Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A paediatric cardiac ECMO programme was established in 2005 at Our Lady's Children's Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal paediatric respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000 Euros/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social impact on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000 Euros. There is now a strong argument for a fully funded single national cardiac and respiratory paediatric ECMO centre, similar to that for adult patients.
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