Pediatric Cardiology

, Volume 34, Issue 6, pp 1422–1430 | Cite as

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

  • Adam W. Lowry
  • David L. S. Morales
  • Daniel E. Graves
  • Jarrod D. Knudson
  • Pirouz Shamszad
  • Antonio R. Mott
  • Antonio G. Cabrera
  • Joseph W. Rossano
Original Article

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.

Keywords

Extracorporeal membrane oxygenation Cardiopulmonary resuscitation Pediatrics 

Supplementary material

246_2013_666_MOESM1_ESM.doc (234 kb)
Supplementary material 1 (DOC 234 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Adam W. Lowry
    • 1
  • David L. S. Morales
    • 2
  • Daniel E. Graves
    • 3
  • Jarrod D. Knudson
    • 4
  • Pirouz Shamszad
    • 5
  • Antonio R. Mott
    • 6
  • Antonio G. Cabrera
    • 7
  • Joseph W. Rossano
    • 6
  1. 1.Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA
  2. 2.Division of Congenital Heart SurgeryCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonUSA
  4. 4.Division of Cardiology, Department of Pediatrics, Batson Children’s HospitalUniversity of Mississippi Medical CenterJacksonUSA
  5. 5.Division of CardiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  6. 6.Section of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, School of MedicineThe University of PennsylvaniaPhiladelphiaUSA
  7. 7.Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of MedicineTexas Children’s HospitalHoustonUSA

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