Characterization of Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest in the United States: Analysis of t
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ORIGINAL ARTICLE
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
Received: 25 December 2012 / Accepted: 9 February 2013 / Published online: 16 March 2013 Springer Science+Business Media New York 2013
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 Electronic supplementary material The online version of this article (doi:10.1007/s00246-013-0666-8) contains supplementary material, which is available to authorized users. A. W. Lowry (&) Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, 750 Welch Rd, Suite 325, Palo Alto, CA 94306, USA e-mail: [email protected]; [email protected] D. L. S. Morales Division of Congenital Heart Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA D. E. Graves Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA J. D. Knudson Division of Cardiology, Department of Pediatrics, Batson Children’s Hospital, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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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
P. Shamszad Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333
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