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

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary support technologies
• Medical device safety

Background:

• Chest tube (CT) placement during pediatric extracorporeal membrane oxygenation (ECMO) has been associated with severe morbidity and mortality.
• Existing literature suggests potential risks, necessitating further investigation into the safety of CT use in this vulnerable population.

Purpose of the Study:

• To evaluate the impact of chest tube (CT) placement on mortality in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
• To determine if CT placement is an independent risk factor for increased mortality in pediatric ECMO patients.

Main Methods:

• Analysis of the Kids' Inpatient Database (KID) from 1997-2009.
• Identification of pediatric ECMO patients with CT placement within 8 days of cannulation.
• Application of multivariate analysis and propensity score matching to compare survival rates between CT and non-CT groups, stratified by age and diagnosis.

Main Results:

• A total of 5884 pediatric ECMO patients were analyzed, with 213 receiving CT placement.
• Overall survival was 57%, with no significant difference observed between patients with and without CT placement.
• Multivariate and propensity score matched analyses confirmed no increased mortality associated with CT placement, irrespective of diagnosis or age (<30 days).

Conclusions:

• Chest tube placement in pediatric ECMO patients is not associated with increased mortality.
• Propensity score matching analysis supports the safety of CT use in pediatric ECMO, challenging previous concerns.
• These findings suggest that CT placement can be safely utilized when clinically indicated in pediatric ECMO patients.