Title

Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation.

Year of Publication

2016

Number of Pages

194-202

Date Published

2016 Mar

ISSN Number

1529-7535

Abstract

<p><strong>OBJECTIVES: </strong>Extracorporeal membrane oxygenation is often used in children with single-ventricle anomalies. We aimed to describe extracorporeal membrane oxygenation use in single-ventricle patients to test the hypothesis that despite increasing prevalence, mortality has not improved and overall burden measure by hospital charges and length of stay have increased.</p>

<p><strong>DESIGN: </strong>Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed with sample weighting to generate national estimates.</p>

<p><strong>PATIENTS: </strong>Pediatric patients (age ≤ 20) with a diagnosis of single ventricle heart disease requiring extracorporeal membrane oxygenation support from 2000 to 2009.</p>

<p><strong>INTERVENTIONS: </strong>None.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>Seven hundred one children (95% CI, 559-943) with single ventricle were supported with extracorporeal membrane oxygenation in the reporting period. Mortality was 57% and did not improve over time (2000 = 52%, 2003 = 63%, 2006 = 57%, and 2009 = 55%; p = 0.66). Single-ventricle patients who required extracorporeal membrane oxygenation were more likely to have had a cardiac procedure (90% vs 46%; p &lt; 0.001), a diagnosis of arrhythmia (22% vs 13%; p &lt; 0.001), cerebrovascular or neurologic insult (9% vs 1%; p &lt; 0.001), heart failure (24% vs 12%; p &lt; 0.001), acute renal failure (28% vs 3%; p &lt; 0.001), or sepsis (28% vs 8%; p &lt; 0.001). By multivariable analysis, acute renal failure was a risk factor for mortality (adjusted odds ratio, 3.12; 95% CI, 1.95-4.98; p &lt; 0.001). The length of stay for single-ventricle patients with extracorporeal membrane oxygenation increased from 25.2 days in 2000 to 55.6 days in 2009 (p &lt; 0.001). Total inflation-adjusted charges increased from $358,021 (95% CI, $278,658-439,765) in 2000 to $732,349 (95% CI, $671,781-792,917) in 2009 (p &lt; 0.001).</p>

<p><strong>CONCLUSIONS: </strong>Extracorporeal membrane oxygenation support is uncommon with single-ventricle admissions occurring in 2.3% of all hospitalizations. Among those patients, the mortality rate was 57% with no change over time. Acute renal failure was an independent risk factor for mortality during hospitalization. In addition, length of stay for these patients increased and hospital charges doubled. Further studies are needed to determine suitability and cost-effectiveness of extracorporeal membrane oxygenation in single-ventricle patients.</p>

DOI

10.1097/PCC.0000000000000616

Alternate Title

Pediatr Crit Care Med

PMID

26808622

WATCH THIS PAGE

Subscription is not available for this page.