title: Relationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis.
abstract: BACKGROUND
  There are very sparse data on the outcomes of children receiving prolonged extracorporeal membrane oxygenation (ECMO) after cardiac surgery. This study was aimed to evaluate the association of ECMO duration with outcomes in children undergoing surgery for congenital heart disease using the Pediatric Health Information System (PHIS) database.
  
  
  METHODS
  Patients aged ≤18 years receiving ECMO after pediatric cardiac surgery (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004-2013) were included. De-identified data obtained from retrospective, observational dataset included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. Outcomes evaluated included in-hospital mortality, length of mechanical ventilation, length of ICU stay, length of hospital stay, and hospital charges. Cox proportional hazards models were fitted to study the probability of study outcomes as a function of ECMO duration.
  
  
  RESULTS
  Nine hundred ninety-eight patients from 37 hospitals qualified for inclusion. The median duration of ECMO run was 4 days (IQR: 1.7). After adjusting for patient and center characteristics, there was 12% increase in the odds of mortality for every 24 hours increase in ECMO duration (OR: 1.12, 95% CI: 1.07-1.18, P<0.001). Patients receiving longer duration of ECMO were associated with longer length of mechanical ventilation, longer length of ICU stay, longer length of hospital stay, and higher hospital charges.
  
  
  CONCLUSIONS
  Data from this large multicenter database suggest that longer duration of ECMO support after pediatric cardiac surgery is associated with worsening outcomes.
authors.affiliation: Division of Pediatric Critical Care, Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA - pgupta2@uams.edu.
authors.forename: P
authors.initials: P
authors.lastname: Gupta
authors.forename: M J
authors.initials: MJ
authors.lastname: Robertson
authors.forename: B
authors.initials: B
authors.lastname: Beam
authors.forename: J M
authors.initials: JM
authors.lastname: Gossett
authors.forename: M L
authors.initials: ML
authors.lastname: Schmitz
authors.forename: C L
authors.initials: CL
authors.lastname: Carroll
authors.forename: J D
authors.initials: JD
authors.lastname: Edwards
authors.forename: J D
authors.initials: JD
authors.lastname: Fortenberry
authors.forename: W
authors.initials: W
authors.lastname: Butt
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome