PMID: 16637521Apr 28, 2006Paper

Heparin-coated adult ECMO vs. ventricular assist devices: a decision analysis modeling approach.

The Journal of Extra-corporeal Technology
Jason R Nance, Joseph J Sistino

Abstract

Postcardiotomy failure requiring ventricular assist occurs in about 1% of adult patients undergoing cardiac surgical procedures. One method of support is a short-term ventricular assist device. This incurs the cost of the device, which is substantial, and allows for reduced anticoagulation in the first 24 hours. Another option is a heparin-coated extracorporeal membrane oxygenation (ECMO) circuit. This also allows for reduced anticoagulation and can support the lungs if necessary. The use of a heparin-coated ECMO circuit requires 24-hour monitoring, but the cost of disposables is considerably less than the cost of ventricular assist devices. This decision analysis uses a Markov model to evaluate the relative outcomes and costs associated with selection between these modalities of support. Data from the past 5 years of patients who received postcardiotomy support will be used to develop the Markov model. The hypothesis is that supporting the patient on heparin-coated ECMO before instituting ventricular assistance will reduce cost and allocate resources in a more cost-effective manner. The model was used to determine the optimal economic time for initiation of ventricular assist devices in postcardiotomy patients. The total costs...Continue Reading

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