A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.

BACKGROUND: The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes. METHOD: A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared. RESULTS: During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events. CONCLUSION: We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes.

The ethanol extract of Cirsium japonicum increased chloride ion influx through stimulating GABA(A) receptor in human neuroblastoma cells and exhibited anxiolytic-like effects in mice.

The aim of the present study was to evaluate the anxiolytic effects of the ethanol extract of Cirsium japonicum (CJ) in mice. The extract was orally administered at dosages of 50, 100, 200, or 400 mg/kg of body weight. The CJ-induced behavioral changes were assessed using the open-field and elevated-plus maze test. The ethanol extract of CJ did not affect overall locomotor activity of mice in the open-field test, however, it showed increase exploration in the unprotected center zone, which is thought to reflect anxiolyticlike effects. Furthermore, the CJ extract (100 and 200 mg/kg) significantly increased the percentage of time spent in the open arms of the elevated plus-maze, indicating the anxiolytic effects of the substance. This anxiolytic effects of the extract were comparable to that of the benzodiazepine, diazepam. To further characterize the anxiolytic activities of CJ, its action on human neuroblastoma cells were assessed. The CJ extract dose-dependently increased chloride ion (Cl(‒)) influx, which was blocked by coadministration of the GABA(A) receptor competitive antagonist, bicuculline, suggesting a GABA(A) receptor - Cl(‒)) channel mechanism of action. Taken altogether, the present study demonstrates that the ethanol extract of CJ has anxiolytic effects, probably mediated through GABAergic neurotransmission.