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Hospital readmissions and survival after nonneonatal pediatric ECMO
1Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS Building, MC 957098, Los Angeles, CA 90095-7098, USA.
Insights
Pediatric patients treated with extracorporeal membrane oxygenation (ECMO) experienced significant long-term health issues, including high readmission rates and late deaths. Higher hospital case volumes correlated with improved long-term survival outcomes.
Area of Science:
- Pediatric critical care medicine
- Extracorporeal membrane oxygenation (ECMO) applications
- Long-term outcomes in pediatric patients
Background:
- The long-term effects of extracorporeal membrane oxygenation (ECMO) in non-neonatal pediatric patients are not well understood.
- Characterizing late morbidities and survival is crucial for optimizing care after ECMO.
Purpose of the Study:
- To determine long-term survival rates in pediatric patients treated with ECMO.
- To analyze hospital readmission rates and associated morbidities in pediatric ECMO survivors.
Main Methods:
- Retrospective analysis of 188 pediatric patients (1 month to 18 years) treated with ECMO from 1999-2006.
- Exclusion of patients with congenital cardiac disease; focus on initial hospital course, readmissions, morbidities, and survival.
- Tracking of survivors for median 3.7 years to assess long-term outcomes and hospital charges.
Main Results:
- 46% of patients survived to hospital discharge; 87 survivors were tracked.
- 62% of survivors were readmitted, with respiratory infections being common (34%).
- 16% experienced neurological conditions; 5% of all patients died late. Higher treatment center case volume improved survival.
Conclusions:
- Pediatric ECMO survivors face substantial long-term morbidities and high readmission rates (>60%).
- Late mortality remains a concern (5%), highlighting the need for ongoing follow-up.
- High-volume ECMO centers are associated with better long-term survival, suggesting a volume-outcome relationship.
Purpose:
The late effects of treatment with extracorporeal membrane oxygenation (ECMO) in nonneonatal pediatric patients remain unclear. The aims of our study were to better characterize the long-term survival and hospital readmission rates for pediatric patients after ECMO treatment.
Patients And Methods:
From 1999 to 2006, data on children aged 1 month to 18 years who underwent ECMO were extracted from the California Patient Discharge Database. Data from patients with diagnoses of congenital cardiac disease were excluded. We analyzed patient data on initial hospital course, subsequent readmissions, development of long-term morbidities, and long-term survival.
Results:
The study cohort consisted of 188 children from 13 California hospitals. The median age was 3 years, and 46% of the patients survived to hospital discharge. ECMO indications included acquired heart disease in 81 patients, pneumonia in 56, other respiratory failure in 22, sepsis in 8, trauma in 8, and other indications in 12. Of the 87 survivors, 56 were tracked for a median period of 3.7 years. The readmission rate was 62%, and the mean time to first readmission was 1.2 years. Readmissions for respiratory infections were observed in 34% of the patients and for reactive airway disease in 7%. Neurologically debilitating conditions (epilepsy [7%] and developmental delay [9%]) occurred in 16%. Late deaths occurred in 5% of the children. Readmitted survivors had a cumulative length of readmission hospitalization of 8 days and hospital charge of $43 000. Cox proportional hazard regression demonstrated a positive relationship between treatment-center case volume and long-term survival outcomes (hazard ratio: 0.98 per case; P < .01).
Conclusions:
Pediatric ECMO survivors suffered from significant long-term morbidities after initial hospital discharge. More than 60% of these children required subsequent readmissions, and late deaths were observed in 5%. Furthermore, hospitals with high case volumes were associated with improved long-term survival.
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