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

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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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References

  1. Ahmed A, Zannad F, Love TE, Tallaj J, Gheorghiade M, Ekundayo OJ et al (2007) A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure. Eur Heart J 28(11):1334–1343

    Article  PubMed  CAS  Google Scholar 

  2. Alsoufi B, Al-Radi OO, Nazer RI, Gruenwald C, Foreman C, Williams WG et al (2007) Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. J Vasc Thorac Cadiovasc Surg 134(4):952–959 e952

    Article  Google Scholar 

  3. Chan T, Thiagarajan RR, Frank D, Bratton SL (2008) Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. J Vasc Thorac Cadiovasc Surg 136(4):984–992

    Article  Google Scholar 

  4. Chen Y-S, Chao A, Yu H-Y, Ko W-J, Wu IH, Chen RJ-C et al (2003) Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol 41(2):197–203

    Article  PubMed  Google Scholar 

  5. Chen Y-S, Lin J-W, Yu H-Y, Ko W-J, Jerng J-S, Chang W-T et al (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis. Lancet 372(9638):554–561

    Article  PubMed  Google Scholar 

  6. Chen Y-S, Yu H-Y, Huang S-C, Lin J-W, Chi N-H, Wang C-H et al (2008) Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation. Crit Care Med 36(9):2529–2535

    Article  PubMed  Google Scholar 

  7. Conrad SA, Rycus PT (2004) Dalton H (2005) Extracorporeal Life Support Registry Report. ASAIO J 51(1):4–10

    Article  Google Scholar 

  8. Cooper S, Janghorbani M, Cooper G (2006) A decade of in-hospital resuscitation: Outcomes and prediction of survival? Resuscitation 68(2):231–237

    Article  PubMed  Google Scholar 

  9. D’Agostino RB Jr (2007) Propensity scores in cardiovascular research. Circulation 115(17):2340–2343

    Article  PubMed  Google Scholar 

  10. Dalton HJ, Siewers RD, Fuhrman BP, del Nido PJ, Thompson AE, Shaver MG et al (1993) Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction. Crit Care Med 21(7):1020–1028

    Article  PubMed  CAS  Google Scholar 

  11. de Mos N, van Litsenburg RR, McCrindle B, Bohn DJ, Parshuram CS (2006) Pediatric in-intensive-care-unit cardiac arrest: Incidence, survival, and predictive factors. Crit Care Med 34(4):1209–1215

    Article  PubMed  Google Scholar 

  12. del Nido PJ, Dalton HJ, Thompson AE, Siewers RD (1992) Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery. Circulation 86(Suppl 5):II300–II304

    PubMed  Google Scholar 

  13. Donoghue A, Berg RA, Hazinski MF, Praestgaard AH, Roberts K, Nadkarni VM (2009) Cardiopulmonary resuscitation for bradycardia with poor perfusion versus pulseless cardiac arrest. Pediatrics 124(6):1541–1548

    Article  PubMed  Google Scholar 

  14. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM et al (2006) Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 71(2):137–145

    Article  PubMed  Google Scholar 

  15. Edelson DP, Litzinger B, Arora V, Walsh D, Kim S, Lauderdale DS et al (2008) Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med 168(10):1063–1069

    Article  PubMed  Google Scholar 

  16. Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) (200, 2003, 2006) Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/kidoverview.jsp. Accessed 1 Oct 2011

  17. Hei F, Lou S, Li J, Yu K, Liu J, Feng Z et al (2011) Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs 35(6):572–578

    Article  PubMed  Google Scholar 

  18. Huang S-C, Wu E-T, Chen Y-S, Chang C-I, Chiu I-S, Wang S–S et al (2008) Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 36(5):1607–1613

    Article  PubMed  Google Scholar 

  19. Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S et al (2010) Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 122(Suppl 11):S241–S248

    Article  PubMed  CAS  Google Scholar 

  20. Kelly RB, Harrison RE (2010) Outcome predictors of pediatric extracorporeal cardiopulmonary resuscitation. Pediatr Cardiol 31(5):626–633

    Article  PubMed  Google Scholar 

  21. Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL et al (2010) Part 14: Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S876–S908

    Article  PubMed  Google Scholar 

  22. Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD et al (2010) Part 10: Pediatric basic and advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122(16 Suppl 2):S466–S515

    Article  PubMed  Google Scholar 

  23. Knudson JD, Neish SR, Cabrera AC, Lowry AW, Shamszad P, Morales DLS et al (2012) Estimated prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: An analysis of the Kids’ Inpatient Database. Crit Care Med 40(11):2940–2944

    Article  PubMed  Google Scholar 

  24. Lin J-W, Wang M-J, Yu H-Y, Wang C-H, Chang W-T, Jerng J-S et al (2010) Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: Propensity analysis of three-year data. Resuscitation 81(7):796–803

    Article  PubMed  Google Scholar 

  25. Lopez-Herce J, Garcia C, Dominguez P, Carrillo A, Rodriguez-Nunez A, Calvo C et al (2004) Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 63(3):311–320

    Article  PubMed  Google Scholar 

  26. Lopez-Herce J, Garcia C, Rodriguez-Nunez A, Dominguez P, Carrillo A, Calvo C et al (2005) Long-term outcome of paediatric cardiorespiratory arrest in Spain. Resuscitation 64(1):79–85

    Article  PubMed  Google Scholar 

  27. Meaney PA, Nadkarni VM, Cook EF, Testa M, Helfaer M, Kaye W et al (2006) Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests. Pediatrics 118(6):2424–2433

    Article  PubMed  Google Scholar 

  28. Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ et al (2009) Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 10(5):544–553

    Article  PubMed  Google Scholar 

  29. Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ et al (2009) In-hospital versus out-of-hospital pediatric cardiac arrest: A multicenter cohort study. Crit Care Med 377:2259–2267

    Article  Google Scholar 

  30. Morris MC, Wernovsky G, Nadkarni VM (2004) Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 5(5):440–446

    Article  PubMed  Google Scholar 

  31. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME et al (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295(1):50–57

    Article  PubMed  CAS  Google Scholar 

  32. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME et al (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295(1):50–57

    Article  PubMed  CAS  Google Scholar 

  33. Ortmann L, Prodhan P, Gossett J, Schexnayder S, Berg R, Nadkarni V et al (2011) Outcomes after in-hospital cardiac arrest in children with cardiac disease: A report from Get With the Guidelines—Resuscitation. Circulation 124(21):2329–2337

    Article  PubMed  Google Scholar 

  34. Parra DA, Totapally BR, Zahn E, Jacobs J, Aldousany A, Burke RP et al (2000) Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit. Crit Care Med 28(9):3296–3300

    Article  PubMed  CAS  Google Scholar 

  35. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME et al (2003) Cardiopulmonary resuscitation of adults in the hospital: A report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58(3):297–308

    Article  PubMed  Google Scholar 

  36. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM et al (2008) Survival from in-hospital cardiac arrest during nights and weekends. JAMA 299(7):785–792

    Article  PubMed  CAS  Google Scholar 

  37. Posner JC, Osterhoudt KC, Mollen CJ, Jacobstein CR, Nicolson SC, Gaynor JW (2000) Extracorporeal membrane oxygenation as a resuscitative measure in the pediatric emergency department. Pediatr Emerg Care 16(6):413–415

    Article  PubMed  CAS  Google Scholar 

  38. Prodhan P, Fiser RT, Dyamenahalli U, Gossett J, Imamura M, Jaquiss RD et al (2009) Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 80(10):1124–1129

    Article  PubMed  Google Scholar 

  39. Prodhan P, Fiser RT, Dyamenahalli U, Gossett J, Imamura M, Jaquiss RDB et al (2009) Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 80(10):1124–1129

    Article  PubMed  Google Scholar 

  40. Ravishankar C, Tabbutt S, Allen K, Cooper DS, Frank DU, Frommelt PC, for the Pediatric Heart Network Investigators, et al (2011) Abstract 9897: Impact of extracorporeal membrane oxygenation and cardiopulmonary resuscitation on Norwood procedure outcomes: Data from the Single Ventricle Reconstruction Trial. Circulation 124(Suppl 21):A9897

    Google Scholar 

  41. Raymond TT, Cunnyngham CB, Thompson MT, Thomas JA, Dalton HJ, Nadkarni VM (2010) Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: A report from the National Registry of Cardiopulmonary Resuscitation. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 11(3):362–371

    Google Scholar 

  42. Sahu S, Kishore K, Lata I (2010) Better outcome after pediatric resuscitation is still a dilemma. J Emerg Trauma Shock 3(3):243–250

    Article  PubMed  Google Scholar 

  43. Samson RA, Nadkarni VM, Meaney PA, Carey SM, Berg MD, Berg RA (2006) Outcomes of in-hospital ventricular fibrillation in children. N Engl J Med 354(22):2328–2339

    Article  PubMed  CAS  Google Scholar 

  44. Sivarajan VB, Best D, Brizard CP, Shekerdemian LS, D’Udekem Y, Butt W (2011) Duration of resuscitation previous to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intensive Care Med 37(5):853–860

    Article  PubMed  Google Scholar 

  45. Slonim AD, Patel KM, Ruttimann UE, Pollack MM (1997) Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med 25(12):1951–1955

    Article  PubMed  CAS  Google Scholar 

  46. Steiner C, Elixhauser A, Schnaier J (2002) The healthcare cost and utilization project: An overview. Eff Clin Pract 5(3):143–151

    PubMed  Google Scholar 

  47. Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C et al (2007) Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73(1):29–39

    Article  PubMed  Google Scholar 

  48. Thiagarajan RR (2011) Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation: Useful, but for whom? Crit Care Med 39(1):190–191

    Article  PubMed  Google Scholar 

  49. Thiagarajan RR, Laussen PC, Rycus PT, Bartlett RH, Bratton SL (2007) Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 116(15):1693–1700

    Article  PubMed  Google Scholar 

  50. Thourani VH, Kirshbom PM, Kanter KR, Simsic J, Kogon BE, Wagoner S et al (2006) Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 82(1):138–144 discussion 144-135

    Article  PubMed  Google Scholar 

  51. Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR et al (2010) Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S676–S684

    Article  PubMed  Google Scholar 

  52. Van Litsenburg R, de Mos N, Edgell D, Gruenwald C, Bohn DJ, Parshuram CS (2005) Resource use and health outcomes of paediatric extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 90(2):F176–F177

    Article  PubMed  Google Scholar 

  53. Varon J, Acosta P (2008) Extracorporeal membrane oxygenation in cardiopulmonary resuscitation: Are we there yet? Crit Care Med 36(9):2685–2686

    Article  PubMed  Google Scholar 

  54. Weil MH, Fries M (2005) In-hospital cardiac arrest. Crit Care Med 33(12):2825–2830

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, 750 Welch Rd, Suite 325, Palo Alto, CA, 94306, USA

    Adam W. Lowry

  2. Division of Congenital Heart Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    David L. S. Morales

  3. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Daniel E. Graves

  4. Division of Cardiology, Department of Pediatrics, Batson Children’s Hospital, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Jarrod D. Knudson

  5. Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Pirouz Shamszad

  6. Section of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, School of Medicine, The University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Antonio R. Mott & Joseph W. Rossano

  7. Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, MC 19345C, Houston, TX, 77030, USA

    Antonio G. Cabrera

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  1. Adam W. Lowry
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Correspondence to Adam W. Lowry.

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Lowry, A.W., Morales, D.L.S., Graves, D.E. et al. Characterization of Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest in the United States: Analysis of the Kids’ Inpatient Database. Pediatr Cardiol 34, 1422–1430 (2013). https://doi.org/10.1007/s00246-013-0666-8

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