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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Association of Pediatric Cardiac Surgical Volume and Mortality After Cardiac ECMO
Cindy S Barrett1, Titus T Chan, Jacob Wilkes
1From the *Department of Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, †Seattle Children's Hospital, University of Washington, Seattle, Washington; ‡Intermountain Healthcare Data Analyst, Salt Lake City, Utah; §University of Utah, Salt Lake City, Utah, and ¶Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Higher cardiac surgical volume, not extracorporeal membrane oxygenation (ECMO) volume, is linked to better survival for pediatric cardiac surgery patients requiring ECMO support. This highlights the importance of surgical expertise in improving outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Membrane Oxygenation (ECMO)
- Healthcare Outcomes Research
Background:
- Centers with high surgical and ECMO volumes show improved survival rates in pediatric cardiac surgery and ECMO cases, respectively.
- The specific impact of combined cardiac surgical and ECMO volumes on survival requires further investigation.
Purpose of the Study:
- To examine the relationship between cardiac surgical volume and cardiac ECMO volume with patient survival.
- To determine which volume metric, surgical or ECMO, is more strongly associated with survival in pediatric patients undergoing cardiac surgery and ECMO.
Main Methods:
- Utilized data from the Pediatric Health Information System (PHIS) for patients undergoing ECMO during hospitalization for cardiac surgery or heart transplantation (January 2003-June 2014).
- Categorized 43 centers into volume quartiles based on annual ECMO and cardiac surgical volumes.
- Employed multivariable logistic regression models, accounting for center clustering and mortality-associated factors.
Main Results:
- Among 106,967 patients, 3,069 (2.9%) received ECMO support.
- Mortality was lower in centers with higher ECMO volume (≥7 runs/year) and higher cardiac surgical volume (≥158 cases/year).
- Cardiac surgical volume demonstrated a stronger association with reduced ECMO mortality and fewer ECMO complications compared to ECMO volume.
Conclusions:
- Higher cardiac surgical volume is more strongly associated with improved survival for pediatric patients on cardiac ECMO than ECMO volume alone.
- Centers with greater cardiac surgical experience may offer better outcomes for complex pediatric cardiac cases requiring ECMO support.
Abstract:
Centers with higher surgical and extracorporeal membrane oxygenation (ECMO) volumes have improved survival for children undergoing pediatric cardiac surgery and ECMO, respectively. We examined the relationship between both cardiac surgical and cardiac ECMO volumes, with survival. Using data from the Pediatric Health Information System, we reviewed patients who underwent ECMO during the hospitalization for cardiac surgery or heart transplantation from January 2003 to June 2014. Among 106,967 patients in 43 centers undergoing a Risk Adjustment for Congenital Heart Surgery-1 1-6 procedure (n = 104,951) or cardiac transplantation (n = 2,016), 2.9% (n = 3,069) underwent ECMO support. Centers were categorized into volume quartiles based on annual ECMO and cardiac surgical volumes. Multivariable logistic regression models controlling for clustering by center and adjusting for factors associated with mortality were constructed. Although mortality was lower in ECMO centers that performed ≥7 ECMO runs (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22-0.88)] and centers performing ≥158 cardiac surgical cases (OR: 0.37, 95% CI: 0.22-0.63), surgical volume was more strongly associated with ECMO mortality. Centers with higher cardiac surgical volume had fewer ECMO complications. Cardiac surgical volume, compared with ECMO volume, is more strongly associated with cardiac ECMO survival.
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