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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane
Tara Karamlou1, Mina Vafaeezadeh, Andrea M Parrish
1Division of Pediatric Cardiac Surgery, University of California, San Francisco, CA, USA.
Insights
Higher extracorporeal membrane oxygenation (ECMO) center volume improves survival for pediatric cardiac patients. This suggests regionalizing ECMO care in specialized centers enhances patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Health services research
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support intervention for critically ill pediatric patients.
- Variability in ECMO center case volumes exists nationally.
- The impact of ECMO center volume on pediatric patient survival is not fully elucidated.
Purpose of the Study:
- To investigate the association between pediatric ECMO center case volume and in-hospital survival.
- To determine if higher ECMO volumes correlate with better outcomes in pediatric patients.
Main Methods:
- Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000-2009).
- Categorization of hospitals into low (<15), medium (15-30), and high (>30 patients/year) ECMO volume tertiles.
- Use of Risk Adjustment for Congenital Heart Surgery (RACHS) categories for cardiac cases and multivariable regression to assess mortality determinants.
Main Results:
- A total of 3867 ECMO cases were identified, estimating 6333 nationally.
- Higher annual ECMO volume was significantly associated with reduced in-hospital mortality (P = .01).
- Low ECMO volume remained an independent predictor of in-hospital death (OR, 1.75; P = .03) after adjustments.
Conclusions:
- Increased extracorporeal membrane oxygenation center case volume is linked to improved survival in pediatric cardiac patients.
- Findings support the development of regionalized centers of excellence for pediatric cardiac ECMO care.
Objective:
We sought to examine the relationship between extracorporeal membrane oxygenation center case volume and survival in pediatric patients requiring extracorporeal membrane oxygenation support.
Methods:
Pediatric patients (≤ 20 years) undergoing extracorporeal membrane oxygenation cannulation were identified using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000 to 2009. Annual hospital extracorporeal membrane oxygenation volume tertiles were <15 patients/year (low volume), 15 to 30 patients/year (medium volume), and >30 patients/year (high volume). Cases of extracorporeal membrane oxygenation were segregated by indication into cardiac and noncardiac groups. Cases of cardiac extracorporeal membrane oxygenation were mapped to Risk Adjustment for Congenital Heart Surgery categories to adjust for case complexity. Weighted multivariable logistic and linear regression models identified determinants of in-hospital mortality.
Results:
Overall, 3867 cases of extracorporeal membrane oxygenation were identified, yielding a national estimate of 6333 ± 495 cases. Extracorporeal membrane oxygenation was used with nearly equivalent prevalence across volume tertiles for all Risk Adjustment for Congenital Heart Surgery categories, suggesting that patient selection for extracorporeal membrane oxygenation was fairly uniform. A higher annual extracorporeal membrane oxygenation volume tertile was associated with reduced in-hospital mortality (P = .01) within nearly all Risk Adjustment for Congenital Heart Surgery categories. After adjustment for Risk Adjustment for Congenital Heart Surgery category and other patient variables, lower extracorporeal membrane oxygenation volume remained an important determinant of in-hospital death (odds ratio, 1.75; 95% confidence interval, 1.03-2.94; P = .03).
Conclusions:
Higher extracorporeal membrane oxygenation case volume is associated with improved hospital survival in pediatric cardiac extracorporeal membrane oxygenation patients. The results of this study may support the paradigm of regionalized centers of excellence for managing pediatric cardiac extracorporeal membrane oxygenation patients.
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