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

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.

Singapore Paediatric Resuscitation Guidelines 2016

“…(70)(71)(72)(73) ECMO, however, was associated with increased complications (e.g. haemorrhage, thrombotic events) and was more resource-intensive.…”

“…haemorrhage, thrombotic events) and was more resource-intensive. (70) In a retrospective review of a paediatric IHCA registry database, ECPR was shown to improve survival in patients with isolated cardiac disease when CPR alone had failed, especially in surgical cardiac patients. (68,70) The majority of survivors who received ECPR had a favourable neurological outcome.…”

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence from 4 pediatric observational studies of IHCA [71][72][73][74] (downgraded for indirectness, inconsistency, and residual confounding) and very-low-quality evidence from 1 unpublished analysis of a study' s public dataset 75 (downgraded for serious risk of residual confounding) showing no benefit to the use of ECPR when compared with CPR without the use of ECMO (RR range, 0.64-1.63). We also identified low-quality evidence (downgraded for indirectness, inconsistency, and residual confounding) from a single pediatric study of IHCA 76 that showed benefit to ECPR when compared with CPR without the use of ECMO (OR, 2.5; 95% CI, 1.3-4.5; P50.007 in surgical cardiac diagnoses; OR, 3.8; 95% CI, 1.4-5.8; P50.011 in medical cardiac diagnoses).…”

“…This therapy may be associated with added complications for individual patients (eg, hemorrhage) and significant costs for a healthcare system. 71 The motivation to examine this topic was to provide guidance on the use of ECMO when used with conventional resuscitation measures for the purpose of optimizing survival, recovery, and neurologic outcome from pediatric IHCA. This review did not evaluate the use of ECPR for the purpose of supporting a patient for the end point of organ donation for transplantation as this may involve different resuscitation goals and targets.…”

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

“…40 Median hospital charges of ECPR patients has been quoted at $310824, which is significantly greater than charges for propensity-matched conventional CPR patients, which are $147817. 42 Financial burdens of ECMO support may far exceed reimbursement from insurance companies and may place the hospital at financial risk. 40,43 Offering excess treatment in one patient may conceivably lead to a decrease in resources for another patient.…”