Development of the Pediatric Extracorporeal Membrane Oxygenation Prediction Model for Risk-Adjusting Mortality*

Abstract

Objective: To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation (ECMO) initiation for children which is important for determining centerspecific risk-adjusted outcomes.Design: Multivariable logistic regression using a large national cohort of pediatric ECMO patients. Setting:The intensive care units of the eight tertiary care children's hospitals of the Collaborative Pediatric Critical Care Research Network Patients: 514 children (< 19 years), enrolled with an initial ECMO run for any indication between January 2012 and September 2014. Interventions: NoneMeasurements and Main Results: A total of 514 first ECMO runs were analyzed with an overall mortality of 45% (n=232). Weighted logistic regression was used for model selection and internal validation was performed using cross validation. The variables included in the Pediatric ECMO Prediction (PEP) model were age (pre-term neonate, full-term neonate, infant, child, and adolescent), indication for ECMO (extracorporeal cardiopulmonary resuscition, cardiac, or respiratory), meconium aspiration, congenital diaphragmatic hernia, documented blood stream infection, arterial blood pH, partial thromboplastin time, and international normalized ratio. The highest risk of mortality was associated with the presence of a documented blood stream infection (OR 5.26; CI 1.90-14.57) followed by extracorporeal cardiopulmonary resuscitation (OR = 4.36;). The c-statistic was 0.75 (95% CI, 0.70-0.80). Conclusions:The PEP model represents a model for predicting in-hospital mortality among children receiving ECMO support for any indication. Consequently, it holds promise as the first comprehensive pediatric ECMO risk stratification model which is important for benchmarking ECMO outcomes across many centers.

Pediatric patients requiring extracorporeal membrane oxygenation in heart failure: 30‐day outcomes; mid‐ and long‐term survival. A single center experience

“…Bailly et al depicted comparable mortality between pediatric patients and neonates confirming our results . Also the working group by Alsoufi et al revealed fine long‐term survival rates in patients who survived the first 30 days after ECMO treatment .…”

Validation of the ‘paediatric extracorporeal membrane oxygenation prediction’ model in a UK extracorporeal membrane oxygenation centre

“…The strengths of the study is that the analysed cohort had a good representation of various diagnosis cohorts, the different types of ECMO support and a nearly identical distribution of the PEP-model based risk categories as the original derivation study. 3 Given the limitations pointed out, our findings should be considered exploratory and this study on its own does not invalidate the PEP-model. A multicentre study with much higher sample size may be useful to confirm our findings and could also lead to an impetus to improve the model if these findings are confirmed.…”

“…The strengths of the study is that the analysed cohort had a good representation of various diagnosis cohorts, the different types of ECMO support and a nearly identical distribution of the PEP-model based risk categories as the original derivation study. 3…”

“…Publication of the 'paediatric ECMO prediction' (PEP) model was a Validation of the 'paediatric extracorporeal membrane oxygenation prediction' model in a UK extracorporeal membrane oxygenation centre significant recent development. 3 The PEP model was derived with the ability to prognosticate in-hospital mortality for all children old who receive ECMO for any indication. This meant that it can be applied to all patients at a single institution or across institutions, regardless of extracorporeal cardiopulmonary resuscitation (ECPR), cardiac or a respiratory indication.…”

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

“…Concerning most aspects of ECMO outcome (patient safety, resource utilization, quality, morbidity, mortality), there is concensus that ECMO is best provided at high-volume ECMO centers (8–10). However, case mix may influence survival data (11), and Bailly et al found no association between center size and outcome (12). As recently as a decade ago, only a small number of centers worldwide provided mobile ECMO services for bedside assessment and cannulae insertion.…”