54例成人体外膜肺氧合辅助心肺复苏的有效性和年成本-效果分析

Effectiveness and annual cost-effectiveness analysis of extracorporeal cardiopulmonary resuscitation in 54 adults

目的分析成人体外膜肺氧合辅助心肺复苏(extracorporcal cardiopulmonary resuscitation,ECPR)的有效性和年成本-效果。方法回顾南京医科大学第一附属医院急诊中心2015年4月至2020年3月60例ECPR的资料,以出院存活/院内死亡、初始可电击/非可电击心律分组,比较年龄、性别、OHCA/IHCA(out-of-hospitalin-hospital cardiac arrest)、初始心律、存活率、ECMO(extracorporcal membrane oxygenation)时间、死亡时间、住院时间、治疗费用的差异。②对存活者进行1年随访,以ECPR治疗总费用作为成本、1年存活率作为预后效果,进行成本-效果分析。结果54例成人ECPR患者纳入分析,出院存活17人(31.5%),其中15人(88.2%)神经功能预后良好且1年随访存活。中位ECMO时间5(IQR 1~8)d、死亡时间4(IQR 1~-9)d.住院时间10(IQR 3~18)d、总费用209122(IQR 121431~303822)RMB、日费用23587(IQR 13439~38217)RMB。出院存活组初始可电击心律的比例显著高于院内死亡组,初始可电击心律组的存活率显著高于非可电击心律组,且治疗成本差异无统计学意义。结论ECPR属于资源密集型治疗,总费用约20万元,初始可电击心律的患者ECPR有效性及年成本-效果显著。

Objective To analyze the effectiveness and annual cost-effectiveness of (extracorporeal cardiopulmonary resuscitation,ECPR)in adults.Methods Totally 60 patients received ECPR from April 2015 to March 2020 in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.The patients were grouped by discharge survival/hospital death and shockable/unshockable initial rhythm.Age,gender,initial rhythm,survival rate,ECMO treatment time,time-to-death,length of stay and hospitalization costs were analyzed.All discharged survivors were followed up for 1 year,then cost-effectiveness analysis was performed using total cost of ECPR as the cost and year survival rate as the effect.Results Fifty-four adult patients with ECPR were enrolled,and 17(31.5%)patients survived and discharged,of whom 15(88.2%)patients had good neurological outcomes and survived at year follow-up.The median ECMO time was 5(IQR 1-8)d,time-to-death was 4(IQR 1-9)d,length of stay was 10(IQR 3-18)d,total hospitalization cost was 209122(IQR 121431-303822)RMB,and the daily cost was 23587(IQR 13439-38217)RMB.The rate of shockable initial rhythm was significantly higher in the discharge survival group than the hospital death group.The survival rate of ECPR patients with shockable initial rhythm was significantly higher than that of patients with unshockable initial rhythm,and there was no difference in cost.Conclusions EC PR is a resource-intensive treatment with a total cost of about 200000 RMB.Moreover,the effectiveness and annual cost-effectiveness are superior for patients with shockable initial rhythm.