Cardiopulmonary Resuscitation: For Any Price?

In a recent issue of DCCN, I read with considerable curiosity the article about cardiopulmonary resuscitation by Whitcomb and Blackman.1 I would like to comment on the economic impact of cardiopulmonary resuscitation on the healthcare system, on which the authors shortly elucidated. Because of significant financial repercussions on the healthcare budget, also in Belgium, the discussion regarding to whether further spread the use of automated external defibrillators in public places, such as sport stadiums and malls, has been put on a higher level of priority in the agenda of our policy makers. When making this assessment, it is crucial to not only focus on the "extra" costs of such a new intervention. Contrary to many other critical care therapies that are often only supportive and therefore may not individually result in improved outcome, cardiopulmonary resuscitation has been credited to directly save lives. As the likelihood for unfavorable outcome or survival with neurological damage increases in case of a delayed and inappropriate approach, a wider spread of automated external defibrillators can help to improve survival rates as early defibrillation is the key issue.

Commonly, new interventions accounting for an additional cost of about $50,000 to $60,000 are considered cost-effective.2 Keeping that in mind, investing in preventive measures such as automated external defibrillators will definitely lead to substantial cost savings, as fewer patients will need expensive intensive care treatment, revalidation, and prolonged stay in long-term care facilities, respectively. Consequently, and given the emotional impact associated with avoidable deaths as well, more and more arguments are put forward to make supplementary efforts to provide automated external defibrillators on a more large-scale basis. Critical and emergency care is extremely expensive and from a societal perspective, costs are estimated between 0.5% and 1.0% of the gross domestic product. Moreover, the demand of critical care is estimated to grow with approximately 5% per year. Although, many nurses/clinicians remain skeptical of economic analyses, cost matters in critical and emergency care can no longer be neglected. In this way, I fully agree with Whitcomb and Blackman stating that "when caregivers fail to make cost-conscious decisions, legislators will make them for us." If we want to ascertain the best care for our patients in the future, both nurses and physicians should actively participate in the ongoing debate concerning how to best allocate the scarce resource available. If not, federal governments and insurance institutions will do this for us.

Dominique M. Vandijck, PhD Student, MSc, MA, RN, CCRN

Department of Critical Care

Ghent University Hospital

De Pintelaan 185

9000 Ghent, Belgium

[email protected]

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