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Relationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis
P Gupta1, M J Robertson, B Beam
1Division of Pediatric Critical Care, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA - pgupta2@uams.edu.
Insights
Prolonged extracorporeal membrane oxygenation (ECMO) after pediatric cardiac surgery is linked to worse outcomes. Longer ECMO duration increases mortality risk and extends hospital stays, ventilation, and intensive care unit time.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- Limited data exist on outcomes for children requiring prolonged extracorporeal membrane oxygenation (ECMO) post-cardiac surgery.
- This study addresses the gap by examining ECMO duration's impact on pediatric congenital heart disease surgery outcomes.
Purpose of the Study:
- To evaluate the association between the duration of extracorporeal membrane oxygenation (ECMO) support and patient outcomes.
- To analyze the impact of ECMO duration on mortality, ventilation, ICU stay, hospital stay, and charges in pediatric cardiac surgery patients.
Main Methods:
- Retrospective analysis of a large multicenter database (Pediatric Health Information System, 2004-2013).
- Included patients aged 18 years or younger undergoing cardiac surgery with ECMO.
- Cox proportional hazards models were used to assess ECMO duration's effect on outcomes.
Main Results:
- A total of 998 patients from 37 hospitals were included, with a median ECMO duration of 4 days.
- Each additional 24 hours of ECMO increased the odds of mortality by 12% (OR: 1.12, P<0.001).
- Longer ECMO duration correlated with increased mechanical ventilation, ICU stay, hospital stay, and hospital charges.
Conclusions:
- Findings from this multicenter study indicate that extended extracorporeal membrane oxygenation support is associated with adverse outcomes.
- Longer ECMO duration in pediatric cardiac surgery patients predicts worse clinical outcomes and increased healthcare resource utilization.
Background:
There are very sparse data on the outcomes of children receiving prolonged extracorporeal membrane oxygenation (ECMO) after cardiac surgery. This study was aimed to evaluate the association of ECMO duration with outcomes in children undergoing surgery for congenital heart disease using the Pediatric Health Information System (PHIS) database.
Methods:
Patients aged ≤18 years receiving ECMO after pediatric cardiac surgery (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004-2013) were included. De-identified data obtained from retrospective, observational dataset included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. Outcomes evaluated included in-hospital mortality, length of mechanical ventilation, length of ICU stay, length of hospital stay, and hospital charges. Cox proportional hazards models were fitted to study the probability of study outcomes as a function of ECMO duration.
Results:
Nine hundred ninety-eight patients from 37 hospitals qualified for inclusion. The median duration of ECMO run was 4 days (IQR: 1.7). After adjusting for patient and center characteristics, there was 12% increase in the odds of mortality for every 24 hours increase in ECMO duration (OR: 1.12, 95% CI: 1.07-1.18, P<0.001). Patients receiving longer duration of ECMO were associated with longer length of mechanical ventilation, longer length of ICU stay, longer length of hospital stay, and higher hospital charges.
Conclusion:
Data from this large multicenter database suggest that longer duration of ECMO support after pediatric cardiac surgery is associated with worsening outcomes.
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