Outcomes and Costs Following Extracorporeal Membrane Oxygenation in Critically Ill Pediatric Patients – A Population-Based Cohort Study
CCCF ePoster library. Fernando S. 11/12/19; 283362; EP51
Dr. Shannon Fernando
Dr. Shannon Fernando
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Topic: Retrospective or Prospective Cohort Study or Case Series

Fernando, Shannon M., MD, MSc1,2; Qureshi, Danial, MSc3,4; Tanuseputro, Peter, MD, MHSc3,4,5,6; Dhanani, Sonny, MD7,8; Guerguerian, Anne-Marie, MD, PhD9,10; Shemie, Sam D., MD11,12; Talarico, Robert, MSc3,4; Fan, Eddy, MD, PhD9,13; Munshi, Laveena, MD, MSc9,14; Rochwerg, Bram, MD, MSc15,16; Scales, Damon C., MD, PhD3,9,17,18; Brodie, Daniel, MD19; Thavorn, Kednapa, PhD3,4,5; Kyeremanteng, Kwadwo, MD, MHA1,4,6

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON
  2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON
  3. ICES, Toronto, ON.
  4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
  5. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
  6. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.
  7. Department of Pediatrics, University of Ottawa, Ottawa, ON.
  8. Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON.
  9. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON.
  10. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON.
  11. Department of Pediatrics, McGill University, Montreal, QC.
  12. Division of Critical Care, Montreal Children's Hospital, Montreal, QC. 
  13. Toronto General Hospital Research Institute, University Health Network, Toronto, ON.
  14. Department of Medicine, Sinai Health System, Toronto, ON.
  15. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON.
  16. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON.
  17. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON.
  18. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.
  19. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY.

Introduction: Extracorporeal membrane oxygenation (ECMO) provides temporary cardiorespiratory support in critically ill children whose heart or lung failure becomes refractory to medical management. Little is known about population-level health outcomes and costs following ECMO in pediatric patients.
Objectives: Determine the short- and long-term outcomes and costs of pediatric patients receiving ECMO for cardiorespiratory support.
Methods: Population-based, retrospective cohort study of pediatric patients (<18 years) receiving ECMO between October 1, 2009, and March 31, 2017 in Ontario, Canada. We identified ECMO use through procedural codes for cannulation, as well as relevant billing codes. We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization, as well as at 7-days, 30-days, 1-year, 2-years, and 5-years following ECMO initiation. We secondarily evaluated disposition at hospital discharge (home vs. continuing care) in survivors, as well as incidence of lung and/or heart transplantation during hospitalization. Finally, we analyzed health system costs (in Canadian dollars) in the 1-year following the date of the index admission.
Results: We captured 256 patients. Mean age at ECMO initiation was 3.6 years (standard deviation [SD] = 5.3), 53.9% were male, and 26.2% lived in the lowest income quintile, compared with 14.1% in the highest. Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 55.5%. Survival at 1-year, 2-years, and 5-years was 50.0%, 48.8%, and 44.1%, respectively. During hospitalization, 40 patients (15.6%) received a VAD, 10 patients (3.9%) received lung transplant, and 11 patients (4.3%) received heart transplant. Among survivors, 99.3% were discharged home. Median total costs among all patients in the year following hospital admission were $143,053 (IQR: $67,175-$293,692). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (Median $115,117, IQR: $55,840-$252,489).
Conclusions: While patients requiring ECMO have significant in-hospital mortality, there is little decrease in long-term survival at 1-year. Nearly all patients surviving to discharge were able to be discharged home. Few patients received heart or lung transplant following ECMO. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs.

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