Post-ECMO chest tube placement: A propensity score-matched survival analysis

Background Severe morbidity and mortality has been reported from chest tube (CT) placement during pediatric extracorporeal membrane oxygenation (ECMO). Methods Kids' Inpatient Database (KID) was analyzed for ECMO with CT placed < 8 days postcannulation (1997-2009). Results Overall, 5884 patients were identified (213 CT) (56% male, 49% white), with a median (IQR) age at ECMO cannulation 7 (117) days, length of stay (LOS) 26 (35) days, and total charges (TC) 342,116 (409,573) USD. Diagnoses included congenital diaphragmatic hernia (CDH) 16%, meconium aspiration (MA) 2%, pulmonary hypertension (PH) 13%, respiratory distress syndrome (RDS) 41%, and cardiac (C) 29%. Survival was overall 57%, CDH 47%, MA 88%, PH 75%, RDS 57%, and C 52%. There were no differences in survival between CT and non-CT patients compared overall, or by diagnosis, or by age < 30 days, or by diagnosis and age < 30 days. Multivariate analysis and propensity score matching for all ages, or < 30 days of age by diagnosis showed no difference in survival between CT and non-CT patients. Conclusion Analysis of KID with correlative propensity score matching demonstrates no increased mortality in pediatric ECMO patients requiring CT placement.