title: Determinants of survival and resource utilization for pediatric extracorporeal membrane oxygenation in the United States 1997-2009.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) remains a vital therapy for children requiring cardiopulmonary support.
  
  
  METHODS
  The Kids' Inpatient Database (KID) was analyzed for ECMO (ICD-9-CM 39.65) patients between 1997 and 2009.
  
  
  RESULTS
  Overall, 8005 cases were identified, consisting of neonatal (ECMO <30days of life; 33%), infant (30days to 1year; 46%), young child (1year to 5years; 9.7%), and older child (>5years; 11%) groups. Patients were most commonly male (56%), Caucasian (49%), and insured by Medicaid (46%). ECMO was indicated for respiratory distress syndrome (RDS; 33%), cardiac and circulatory congenital anomalies (CCCA; 22%), congenital diaphragmatic hernia (CDH; 13%), and persistent pulmonary hypertension of the newborn (PPHN; 10%). On multivariate analysis, length of stay (LOS) decreased over the study period, while total charges (TC) increased over time, p<0.001. Survival was higher for boys and those treated in large or urban teaching hospitals, p<0.05. ECMO for CDH, CCCA, and RDS had the highest associated mortality, p<0.001. Neonatal and infant ECMO had no difference in mortality vs. older children.
  
  
  CONCLUSIONS
  While LOS for ECMO has decreased over time, TC has increased steadily. Improved survival is found in boys and patients at large or urban teaching hospitals. CDH, CCCA, and RDS portend poor survival outcomes as indicators for ECMO.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Bokman
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: South Florida Pediatric Surgeons P.A., Plantation, FL, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Lasko
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: jsola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Extracorporeal membrane oxygenation; Health resources; Pediatrics