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 in | Pediatric cardiology Vol. 34; no. 6; pp. 1422 - 1430 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Boston
Springer US
01.08.2013
Springer |
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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. |
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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 – sequence: 2 givenname: David L. S. surname: Morales fullname: Morales, David L. S. organization: Division of Congenital Heart Surgery, Cincinnati Children’s Hospital Medical Center – sequence: 3 givenname: Daniel E. surname: Graves fullname: Graves, Daniel E. organization: Department of Physical Medicine and Rehabilitation, Baylor College of Medicine – sequence: 4 givenname: Jarrod D. surname: Knudson fullname: Knudson, Jarrod D. organization: Division of Cardiology, Department of Pediatrics, Batson Children’s Hospital, University of Mississippi Medical Center – sequence: 5 givenname: Pirouz surname: Shamszad fullname: Shamszad, Pirouz organization: Division of Cardiology, Cincinnati Children’s Hospital Medical Center – sequence: 6 givenname: Antonio R. surname: Mott fullname: Mott, Antonio R. organization: Section of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, School of Medicine, The University of Pennsylvania – sequence: 7 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 |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23503928$$D View this record in MEDLINE/PubMed |
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28 ME Kleinman (666_CR22) 2010; 122 JC Posner (666_CR37) 2000; 16 DA Kane (666_CR19) 2010; 122 Y-S Chen (666_CR5) 2008; 372 DP Edelson (666_CR15) 2008; 168 S Sahu (666_CR42) 2010; 3 VB Sivarajan (666_CR44) 2011; 37 C Ravishankar (666_CR40) 2011; 124 Y-S Chen (666_CR4) 2003; 41 Y-S Chen (666_CR6) 2008; 36 PA Meaney (666_CR27) 2006; 118 JD Knudson (666_CR23) 2012; 40 MH Weil (666_CR54) 2005; 33 L Ortmann (666_CR33) 2011; 124 TT Raymond (666_CR41) 2010; 11 FW Moler (666_CR29) 2009; 377 RB D’Agostino Jr (666_CR9) 2007; 115 MA Peberdy (666_CR36) 2008; 299 P Prodhan (666_CR38) 2009; 80 RB Kelly (666_CR20) 2010; 31 SA Conrad (666_CR7) 2004; 51 VM Nadkarni (666_CR32) 2006; 295 RA Samson (666_CR43) 2006; 354 MC Morris (666_CR30) 2004; 5 J Lopez-Herce (666_CR25) 2004; 63 A Donoghue (666_CR13) 2009; 124 KL Meert (666_CR28) 2009; 10 RR Thiagarajan (666_CR48) 2011; 39 J Varon (666_CR53) 2008; 36 J-W Lin (666_CR24) 2010; 81 R Litsenburg Van (666_CR52) 2005; 90 N Mos de (666_CR11) 2006; 34 S-C Huang (666_CR18) 2008; 36 RR Thiagarajan (666_CR49) 2007; 116 ME Kleinman (666_CR21) 2010; 122 K Sunde (666_CR47) 2007; 73 P Prodhan (666_CR39) 2009; 80 666_CR16 VH Thourani (666_CR50) 2006; 82 DP Edelson (666_CR14) 2006; 71 J Lopez-Herce (666_CR26) 2005; 64 VM Nadkarni (666_CR31) 2006; 295 B Alsoufi (666_CR2) 2007; 134 HJ Dalton (666_CR10) 1993; 21 MA Peberdy (666_CR35) 2003; 58 AD Slonim (666_CR45) 1997; 25 T Chan (666_CR3) 2008; 136 S Cooper (666_CR8) 2006; 68 C Steiner (666_CR46) 2002; 5 AH Travers (666_CR51) 2010; 122 A Ahmed (666_CR1) 2007; 28 PJ Nido del (666_CR12) 1992; 86 F Hei (666_CR17) 2011; 35 |
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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 |
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