title: Outcomes of Single-Ventricle Patients Supported With Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed with sample weighting to generate national estimates.
  
  
  METHODS
  Pediatric patients (age ≤ 20) with a diagnosis of single ventricle heart disease requiring extracorporeal membrane oxygenation support from 2000 to 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  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 < 0.001), a diagnosis of arrhythmia (22% vs 13%; p < 0.001), cerebrovascular or neurologic insult (9% vs 1%; p < 0.001), heart failure (24% vs 12%; p < 0.001), acute renal failure (28% vs 3%; p < 0.001), or sepsis (28% vs 8%; p < 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 < 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 < 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 < 0.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Department of Pediatrics, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 2Department of Anesthesiology and Critical Care Medicine, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3Department of Surgery, the Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Misfeldt
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Kirsch
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Mascio
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.forename: Xumei
authors.initials: X
authors.lastname: Zhang
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Mott
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006352:Heart Ventricles / Q000002:abnormalities; D017722:Hospital Charges / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology