[Source: PLoS One, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study
Katharine Robb , Aditya Badheka , Tong Wang, Sankeerth Rampa, Veerasathpurush Allareddy, Veerajalandhar Allareddy
Published: April 26, 2019 / DOI: https://doi.org/10.1371/journal.pone.0215730
The American College of Critical Care Medicine recommends that children with persistent fluid, catecholamine, and hormone-resistant septic shock be considered for extracorporeal membrane oxygenation (ECMO) support. Current national estimates of ECMO use in hospitalized children with sepsis are unknown. We sought to examine the use of ECMO in these children and to examine the overall outcomes such as in-hospital mortality, length of stay (LOS), and hospitalization charges (HC).
A retrospective analysis of the National Inpatient Sample, which approximates a 20% stratified sample of all discharges from United States community hospitals, was performed. All children (≤ 17 years) who were hospitalized for sepsis between 2012 and 2014 were included. The associations between ECMO and outcomes were examined by multivariable linear and logistic regression models.
A total of 62,310 children were included in the study. The mean age was 4.2 years. ECMO was provided to 415 of the children (0.67% of the cohort with sepsis). Comparative outcomes of sepsis in children who received ECMO versus those who did not included in-hospital mortality rate (41% vs 2.8%), mean HC ($749,370 vs $90,568) and mean LOS (28.8 vs 9.1 days). After adjusting for confounding factors, children receiving ECMO had higher odds of mortality (OR 11.15, 95% CI 6.57–18.92, p < 0.001), longer LOS (6.6 days longer, p = 0.0004), and higher HC ($510,523 higher, p < 0.0001).
Use of ECMO in children with sepsis is associated with considerable resource utilization but has 59% survival to discharge. Further studies are needed to examine the post discharge and neurocognitive outcomes in survivors.
Citation: Robb K, Badheka A, Wang T, Rampa S, Allareddy V, Allareddy V (2019) Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. PLoS ONE 14(4): e0215730. https://doi.org/10.1371/journal.pone.0215730
Editor: Andrea Ballotta, IRCCS Policlinico S.Donato, ITALY
Received: July 19, 2018; Accepted: April 8, 2019; Published: April 26, 2019
Copyright: © 2019 Robb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data user agreement (with AHRQ-HCUP) precludes us from releasing any data. This is standard for all publications originating from NIS (HCUP datasets). Authors should not release data. However, the authors are allowed to disclose the pathway to access of all data. The NIS releases for data years 1988 through 2016 are available for purchase online through the Online HCUP Central Distributor. All HCUP data users, including data purchasers and collaborators, must complete the online HCUP Data Use Agreement Training Tool, and must read and sign the Data Use Agreement for Nationwide Databases (PDF file, 86 KB; HTML). Questions about purchasing databases can be directed to the HCUP Central Distributor: Email: HCUPDistributor@AHRQ.gov Telephone: (866) 556-4287 (toll free) Fax: (866) 792-5313 (toll free).
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: ECMO, extracorporeal membrane oxygenation; LOS, length of stay; NIS, National (Nationwide) Inpatient Sample; ACCM, American College of Critical Care Medicine; AHRQ, Agency for Healthcare Research and Quality; HCUP, Healthcare Cost and Utilization Project
Keywords: ECMO; Sepsis; Pediatrics; USA.