Pediatric Extracorporeal Membrane Oxygenation Mortality Is Related to Extracorporeal Membrane Oxygenation Volume in...

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary support technologies
• Health services research

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-support technology for severe cardiorespiratory failure.
• Understanding the relationship between hospital ECMO volume and patient outcomes is crucial for quality improvement.
• Pediatric ECMO centers face unique challenges related to patient population and resource allocation.

Purpose of the Study:

• To investigate the association between pediatric and overall extracorporeal membrane oxygenation (ECMO) volumes and mortality rates in pediatric patients.
• To identify optimal hospital ECMO volume thresholds for improving survival.
• To compare outcomes between high-volume pediatric ECMO centers and high-volume non-pediatric ECMO centers.

Main Methods:

• Analysis of State Inpatient Databases from 17 states (2008-2014) for pediatric ECMO admissions.
• Classification of hospitals as pediatric ECMO centers (>90% of patients ≤18 years old).
• Categorization of hospital ECMO volumes (overall admissions) into <6, 6-14, 15-30, and >30 annually; multivariable analyses performed.

Main Results:

• 4546 pediatric ECMO admissions across 84 hospitals were analyzed; 59.9% were neonates.
• 35% of pediatric ECMO centers had fewer than 6 annual admissions.
• Hospitals with >30 annual ECMO admissions demonstrated significantly lower mortality compared to lower-volume centers. High-volume pediatric centers had lower mortality (17.4%) than high-volume non-pediatric centers (38.2%).

Conclusions:

• A significant number of hospitals performing pediatric ECMO have low annual patient volumes.
• Higher ECMO volume in pediatric centers is associated with substantially reduced risk-adjusted mortality rates.
• Centralization of pediatric ECMO care in high-volume centers may improve survival outcomes.