title: The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.
abstract: Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system.
  
  
  
  We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3).
  
  
  
  Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively.
  
  
  
  Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Padalino
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tessari
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Alvise
authors.initials: A
authors.lastname: Guariento
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.affiliation: Department of Business and Administration, University Hospital, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marcolongo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zanella
authors.affiliation: Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Harvey
authors.affiliation: Department of Cardiology, Children's Hospital, Harvard Medical School Boston, Boston, MA, USA.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003363:Cost Control; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000191:economics / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Congenital–Acyanotic; Congenital–Cyanotic; ECLS (VA); Extracorporeal circulation; Perioperative issues and risk analysis