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J Surg Res. 2019 Apr;236:159-165. doi: 10.1016/j.jss.2018.11.043. Epub 2018 Dec 17.

Pediatric Extracorporeal Membrane Oxygenation Mortality Is Related to Extracorporeal Membrane Oxygenation Volume in US Hospitals.

Author information

1
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
2
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Katherine.Deans@nationwidechildrens.org.

Abstract

BACKGROUND:

Our objective was to examine extracorporeal membrane oxygenation (ECMO) utilization and determine whether pediatric-specific and overall ECMO volumes are associated with mortality rates.

METHODS:

State Inpatient Databases from 17 states were queried for ECMO admissions during 2008-2014. Hospitals in which >90% of their ECMO patients were ≤18 y old were considered pediatric ECMO centers. Hospital overall ECMO volumes were calculated as the average annual number of admissions, of any age, and categorized as <6, 6-14, 15-30, and >30. Multivariable analyses were conducted to examine the impact of ECMO volume on pediatric in-hospital mortality.

RESULTS:

There were 4546 pediatric ECMO admissions across 84 hospitals. Most patients were neonates (59.9%), and the most common indication for ECMO was neonatal respiratory failure (20.1%). Approximately 35% of hospitals offering pediatric ECMO averaged <6 annual ECMO admissions. Centers with >30 annual ECMO admissions had significantly lower mortality than hospitals with lower ECMO volume. Among the high-volume centers, pediatric ECMO centers had significantly lower mortality rates than high-volume nonpediatric ECMO centers (17.4% versus 38.2%).

CONCLUSIONS:

A high proportion of hospitals performing pediatric ECMO have a low number of annual ECMO admissions. Pediatric centers with high volume had the lowest risk-adjusted mortality rates for pediatric ECMO.

KEYWORDS:

ECMO; Mortality; Pediatric; Survival; Volume

PMID:
30694751
DOI:
10.1016/j.jss.2018.11.043

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