Determinants of survival and resource utilization for pediatric extracorporeal membrane oxygenation in the United States 1997–2009

Abstract Background Extracorporeal membrane oxygenation (ECMO) remains a vital therapy for children requiring cardiopulmonary support. Methods The Kids' Inpatient Database (KID) was analyzed for ECMO (ICD-9-CM 39.65) patients between 1997 and 2009. Results Overall, 8005 cases were identified, c...

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Bibliographic Details
Published in:Journal of pediatric surgery 2015-05, Vol.50 (5), p.809-814
Main Authors: Bokman, Christine L, Tashiro, Jun, Perez, Eduardo A, Lasko, David S, Sola, Juan E
Format: Article
Language:English
Subjects:
Child, Preschool
Extracorporeal membrane oxygenation
Extracorporeal Membrane Oxygenation - mortality
Extracorporeal Membrane Oxygenation - utilization
Female
Health resources
Health Resources - utilization
Hernias, Diaphragmatic, Congenital - mortality
Hernias, Diaphragmatic, Congenital - therapy
Humans
Infant
Infant, Newborn
Male
Pediatrics
Surgery
Survival Rate - trends
United States - epidemiology
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Summary:Abstract Background Extracorporeal membrane oxygenation (ECMO) remains a vital therapy for children requiring cardiopulmonary support. Methods The Kids' Inpatient Database (KID) was analyzed for ECMO (ICD-9-CM 39.65) patients between 1997 and 2009. Results Overall, 8005 cases were identified, consisting of neonatal (ECMO < 30 days of life; 33%), infant (30 days to 1 year; 46%), young child (1 year to 5 years; 9.7%), and older child (> 5 years; 11%) groups. Patients were most commonly male (56%), Caucasian (49%), and insured by Medicaid (46%). ECMO was indicated for respiratory distress syndrome (RDS; 33%), cardiac and circulatory congenital anomalies (CCCA; 22%), congenital diaphragmatic hernia (CDH; 13%), and persistent pulmonary hypertension of the newborn (PPHN; 10%). On multivariate analysis, length of stay (LOS) decreased over the study period, while total charges (TC) increased over time, p < 0.001. Survival was higher for boys and those treated in large or urban teaching hospitals, p < 0.05. ECMO for CDH, CCCA, and RDS had the highest associated mortality, p < 0.001. Neonatal and infant ECMO had no difference in mortality vs. older children. Conclusions While LOS for ECMO has decreased over time, TC has increased steadily. Improved survival is found in boys and patients at large or urban teaching hospitals. CDH, CCCA, and RDS portend poor survival outcomes as indicators for ECMO.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2015.02.042