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

Christine L. Bokman, Jun Tashiro, Eduardo Perez, David S. Lasko, Juan E Sola

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)809-814
Number of pages6
JournalJournal of Pediatric Surgery
Volume50
Issue number5
DOIs
StatePublished - May 1 2015

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Extracorporeal Membrane Oxygenation
Pediatrics
Survival
Urban Hospitals
Teaching Hospitals
Length of Stay
Persistent Fetal Circulation Syndrome
Mortality
Medicaid
International Classification of Diseases
Inpatients
Multivariate Analysis
Databases

Keywords

  • Extracorporeal membrane oxygenation
  • Health resources
  • Pediatrics

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Determinants of survival and resource utilization for pediatric extracorporeal membrane oxygenation in the United States 1997-2009. / Bokman, Christine L.; Tashiro, Jun; Perez, Eduardo; Lasko, David S.; Sola, Juan E.

In: Journal of Pediatric Surgery, Vol. 50, No. 5, 01.05.2015, p. 809-814.

Research output: Contribution to journalArticle

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AB - 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.

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