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Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children-a
Shannon M Fernando1,2, Danial Qureshi3,4,5, Peter Tanuseputro3,4,5,6,7
1Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfern014@uottawa.ca.
Insights
Pediatric patients needing extracorporeal membrane oxygenation (ECMO) have significant in-hospital mortality but stable long-term survival. Costs are substantial, mainly from the initial hospital stay, not post-discharge care.
Area of Science:
- Pediatric critical care medicine
- Cardiorespiratory support technologies
Background:
- Extracorporeal membrane oxygenation (ECMO) provides vital temporary cardiorespiratory support for critically ill children.
- While short-term outcomes and costs are documented, long-term survival and associated expenses for pediatric ECMO patients remain less understood.
Purpose of the Study:
- To evaluate long-term survival rates in pediatric patients following ECMO treatment.
- To assess the total healthcare costs incurred by pediatric ECMO survivors within the first year post-treatment.
Main Methods:
- A population-based cohort study was conducted in Ontario, Canada, from October 2009 to March 2017.
- Pediatric patients (<18 years) receiving ECMO were identified and linked to provincial health databases to track survival and costs.
Main Results:
- The study analyzed 342 pediatric patients, with a mean age of 2.9 years at ECMO initiation.
- Overall survival to hospital discharge was 56.4%, with 5-year survival at 42.1%.
- Median total costs in the year following hospital admission were $147,957, primarily driven by inpatient costs during the index admission.
Conclusions:
- Pediatric patients requiring ECMO face significant in-hospital mortality, yet long-term survival shows minimal decline at one year.
- Substantial median costs are mainly attributable to the initial inpatient stay, not subsequent outpatient care.
- Findings aid healthcare providers in prognostication of outcomes and long-term healthcare expenses for pediatric ECMO survivors.
Background:
Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs.
Methods:
Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO.
Results:
We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571-$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839-$250,675).
Conclusions:
Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.
