Characterization of Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest in the United States: Analysis of the Kids’ Inpatient Database

To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids’ Inpatient Database (KID) was p...

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Published inPediatric cardiology Vol. 34; no. 6; pp. 1422 - 1430
Main Authors Lowry, Adam W., Morales, David L. S., Graves, Daniel E., Knudson, Jarrod D., Shamszad, Pirouz, Mott, Antonio R., Cabrera, Antonio G., Rossano, Joseph W.
Format Journal Article
LanguageEnglish
Published Boston Springer US 01.08.2013
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Abstract To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids’ Inpatient Database (KID) was performed. All CPR episodes were identified; E-CPR was defined as ECMO used on the same day as CPR. Channeling bias was decreased by developing propensity scores representing the likelihood of requiring E-CPR. Univariable, multivariable, and propensity-matched analyses were performed to characterize the influence of E-CPR on survival. There were 8.6 million pediatric hospitalizations and 9,000 CPR events identified in the database. ECMO was used in 82 (0.9 %) of the CPR events. Median hospital charges for E-CPR survivors were $310,824 [interquartile range (IQR) 263,344–477,239] compared with $147,817 (IQR 62,943–317,553) for propensity-matched conventional CPR (C-CPR) survivors. Median LOS for E-CPR survivors (31 days) was considerably greater than that of propensity-matched C-CPR survivors (18 days). Unadjusted E-CPR mortality was higher relative to C-CPR (65.9 vs. 50.9 %; OR 1.9, 95 % confidence interval 1.2–2.9). Neither multivariable analysis nor propensity-matched analysis identified a significant difference in survival between groups. E-CPR is infrequently used for pediatric in-hospital cardiac arrest. Median LOS and charges are considerably greater for E-CPR survivors with C-CPR survivors. In this retrospective administrative database analysis, E-CPR did not significantly influence survival. Further study is needed to improve outcomes and to identify patients most likely to benefit from this resource-intensive therapy.
AbstractList To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids' Inpatient Database (KID) was performed. All CPR episodes were identified; E-CPR was defined as ECMO used on the same day as CPR. Channeling bias was decreased by developing propensity scores representing the likelihood of requiring E-CPR. Univariable, multivariable, and propensity-matched analyses were performed to characterize the influence of E-CPR on survival. There were 8.6 million pediatric hospitalizations and 9,000 CPR events identified in the database. ECMO was used in 82 (0.9 %) of the CPR events. Median hospital charges for E-CPR survivors were $310,824 [interquartile range (IQR) 263,344-477,239] compared with $147,817 (IQR 62,943-317,553) for propensity-matched conventional CPR (C-CPR) survivors. Median LOS for E-CPR survivors (31 days) was considerably greater than that of propensity-matched C-CPR survivors (18 days). Unadjusted E-CPR mortality was higher relative to C-CPR (65.9 vs. 50.9 %; OR 1.9, 95 % confidence interval 1.2-2.9). Neither multivariable analysis nor propensity-matched analysis identified a significant difference in survival between groups. E-CPR is infrequently used for pediatric in-hospital cardiac arrest. Median LOS and charges are considerably greater for E-CPR survivors with C-CPR survivors. In this retrospective administrative database analysis, E-CPR did not significantly influence survival. Further study is needed to improve outcomes and to identify patients most likely to benefit from this resource-intensive therapy.
To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids’ Inpatient Database (KID) was performed. All CPR episodes were identified; E-CPR was defined as ECMO used on the same day as CPR. Channeling bias was decreased by developing propensity scores representing the likelihood of requiring E-CPR. Univariable, multivariable, and propensity-matched analyses were performed to characterize the influence of E-CPR on survival. There were 8.6 million pediatric hospitalizations and 9,000 CPR events identified in the database. ECMO was used in 82 (0.9 %) of the CPR events. Median hospital charges for E-CPR survivors were $310,824 [interquartile range (IQR) 263,344–477,239] compared with $147,817 (IQR 62,943–317,553) for propensity-matched conventional CPR (C-CPR) survivors. Median LOS for E-CPR survivors (31 days) was considerably greater than that of propensity-matched C-CPR survivors (18 days). Unadjusted E-CPR mortality was higher relative to C-CPR (65.9 vs. 50.9 %; OR 1.9, 95 % confidence interval 1.2–2.9). Neither multivariable analysis nor propensity-matched analysis identified a significant difference in survival between groups. E-CPR is infrequently used for pediatric in-hospital cardiac arrest. Median LOS and charges are considerably greater for E-CPR survivors with C-CPR survivors. In this retrospective administrative database analysis, E-CPR did not significantly influence survival. Further study is needed to improve outcomes and to identify patients most likely to benefit from this resource-intensive therapy.
Audience Academic
Author Morales, David L. S.
Rossano, Joseph W.
Cabrera, Antonio G.
Knudson, Jarrod D.
Shamszad, Pirouz
Lowry, Adam W.
Graves, Daniel E.
Mott, Antonio R.
Author_xml – sequence: 1
  givenname: Adam W.
  surname: Lowry
  fullname: Lowry, Adam W.
  email: adamlowry@gmail.com, adam.lowry@stanford.edu
  organization: Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University
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  givenname: David L. S.
  surname: Morales
  fullname: Morales, David L. S.
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  givenname: Daniel E.
  surname: Graves
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  organization: Section of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, School of Medicine, The University of Pennsylvania
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  givenname: Antonio G.
  surname: Cabrera
  fullname: Cabrera, Antonio G.
  organization: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital
– sequence: 8
  givenname: Joseph W.
  surname: Rossano
  fullname: Rossano, Joseph W.
  organization: Section of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, School of Medicine, The University of Pennsylvania
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Snippet To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among...
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SubjectTerms Analysis
Cardiac arrest
Cardiac Surgery
Cardiology
Children
Confidence Intervals
Extracorporeal Membrane Oxygenation - methods
Female
Follow-Up Studies
Health aspects
Heart Arrest - mortality
Heart Arrest - therapy
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Inpatients
Male
Medical colleges
Medicine
Medicine & Public Health
Original Article
Pediatric cardiology
Retrospective Studies
Survival Rate - trends
United States - epidemiology
Vascular Surgery
Title Characterization of Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest in the United States: Analysis of the Kids’ Inpatient Database
URI https://link.springer.com/article/10.1007/s00246-013-0666-8
https://www.ncbi.nlm.nih.gov/pubmed/23503928
https://search.proquest.com/docview/1401092478
Volume 34
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