Tags

Type your tag names separated by a space and hit enter

Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study.
PLoS One. 2019; 14(4):e0215730.Plos

Abstract

OBJECTIVE

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).

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Division of Critical Care, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, United States of America.Division of Critical Care, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, United States of America.Department of Management Sciences, Tippie College of Business, University of Iowa, Iowa City, Iowa, United States of America.Management & Marketing Department, School of Business, Rhode Island College, Providence, Rhode Island, United States of America.Brodie Craniofacial Endowed Chair, Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, United States of America.Duke University Medical Center, Durham, North Carolina, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31026292

Citation

Robb, Katharine, et al. "Use of Extracorporeal Membrane Oxygenation and Associated Outcomes in Children Hospitalized for Sepsis in the United States: a Large Population-based Study." PloS One, vol. 14, no. 4, 2019, pp. e0215730.
Robb K, Badheka A, Wang T, et al. Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. PLoS One. 2019;14(4):e0215730.
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
Robb K, et al. Use of Extracorporeal Membrane Oxygenation and Associated Outcomes in Children Hospitalized for Sepsis in the United States: a Large Population-based Study. PLoS One. 2019;14(4):e0215730. PubMed PMID: 31026292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. AU - Robb,Katharine, AU - Badheka,Aditya, AU - Wang,Tong, AU - Rampa,Sankeerth, AU - Allareddy,Veerasathpurush, AU - Allareddy,Veerajalandhar, Y1 - 2019/04/26/ PY - 2018/07/19/received PY - 2019/04/08/accepted PY - 2019/4/27/entrez PY - 2019/4/27/pubmed PY - 2020/2/15/medline SP - e0215730 EP - e0215730 JF - PloS one JO - PLoS One VL - 14 IS - 4 N2 - OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31026292/Use_of_extracorporeal_membrane_oxygenation_and_associated_outcomes_in_children_hospitalized_for_sepsis_in_the_United_States:_A_large_population_based_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0215730 DB - PRIME DP - Unbound Medicine ER -