在VA ECMO中,与机械左心室机械卸载设备相关的医院费用,用于成人心脏性休克
medRxiv : the preprint server for health sciences
|April 16, 2025
概括
将左心室机械卸载 (LVMU) 添加到静脉动脉外体膜氧化 (VA ECMO) 增加了成本,但显著降低了心脏性休克患者的死亡率. 这种理解有助于资源分配.
科学领域:
- 心血管医学 心血管医学
- 医疗技术 医疗技术 医学技术
- 卫生经济学 卫生经济学
背景情况:
- 静脉动脉外体膜氧化 (VA ECMO) 越来越多地用于心脏性休克 (CS).
- 结合VA ECMO与左心室机械卸载 (LVMU) 的财务影响和影响仍未得到充分研究.
- 了解这些成本对于继续采用和适当使用VA ECMO至关重要.
研究的目的:
- 将仅使用VA ECMO治疗的CS患者的住院费用和临床结果与使用VA ECMO加LVMU治疗的患者进行比较.
- 分析与不同机械循环支持策略相关的财务负担和死亡率.
主要方法:
- 使用IBM MarketScan数据库 (2008-2021) 的成年CS患者的回顾性队列研究.
- 分析住院费用,住院时间 (LOS) 和住院死亡率.
- 倾向性得分匹配用于平衡接受LVMU和未接受LVMU的组之间的患者特征.
主要成果:
- 接受VA ECMO + LVMU治疗的患者的住院总费用中位数 (390,508美元) 与仅接受VA ECMO治疗 (320,269美元) 相比较高.
- 与没有设备相比,单独使用VA ECMO (3.0x),单独使用LVMU (2.6x) 和VA ECMO + LVMU (4.2x) 的每日成本显著更高.
- VA ECMO + LVMU与显著降低的死亡率 (HR=0.62) 相关,但较长的医院LOS.
结论:
- 将VA ECMO与LVMU相结合,导致医疗保健成本增加和住院时间延长.
- 尽管成本较高,但LVMU与VA ECMO一起显著提高了CS患者的生存率.
- 这些发现对于在关键心脏病护理中关于资源配置的知情决策至关重要.
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