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Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. METHODS: Population-based cohort...

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Autores principales: Fernando, Shannon M., Qureshi, Danial, Tanuseputro, Peter, Dhanani, Sonny, Guerguerian, Anne-Marie, Shemie, Sam D., Talarico, Robert, Fan, Eddy, Munshi, Laveena, Rochwerg, Bram, Scales, Damon C., Brodie, Daniel, Thavorn, Kednapa, Kyeremanteng, Kwadwo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137509/
https://www.ncbi.nlm.nih.gov/pubmed/32252807
http://dx.doi.org/10.1186/s13054-020-02844-3
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author Fernando, Shannon M.
Qureshi, Danial
Tanuseputro, Peter
Dhanani, Sonny
Guerguerian, Anne-Marie
Shemie, Sam D.
Talarico, Robert
Fan, Eddy
Munshi, Laveena
Rochwerg, Bram
Scales, Damon C.
Brodie, Daniel
Thavorn, Kednapa
Kyeremanteng, Kwadwo
author_facet Fernando, Shannon M.
Qureshi, Danial
Tanuseputro, Peter
Dhanani, Sonny
Guerguerian, Anne-Marie
Shemie, Sam D.
Talarico, Robert
Fan, Eddy
Munshi, Laveena
Rochwerg, Bram
Scales, Damon C.
Brodie, Daniel
Thavorn, Kednapa
Kyeremanteng, Kwadwo
author_sort Fernando, Shannon M.
collection PubMed
description BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. METHODS: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. RESULTS: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1–13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571–$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839–$250,675). CONCLUSIONS: Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.
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spelling pubmed-71375092020-04-11 Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study Fernando, Shannon M. Qureshi, Danial Tanuseputro, Peter Dhanani, Sonny Guerguerian, Anne-Marie Shemie, Sam D. Talarico, Robert Fan, Eddy Munshi, Laveena Rochwerg, Bram Scales, Damon C. Brodie, Daniel Thavorn, Kednapa Kyeremanteng, Kwadwo Crit Care Research BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. METHODS: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. RESULTS: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1–13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571–$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839–$250,675). CONCLUSIONS: Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors. BioMed Central 2020-04-06 /pmc/articles/PMC7137509/ /pubmed/32252807 http://dx.doi.org/10.1186/s13054-020-02844-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Fernando, Shannon M.
Qureshi, Danial
Tanuseputro, Peter
Dhanani, Sonny
Guerguerian, Anne-Marie
Shemie, Sam D.
Talarico, Robert
Fan, Eddy
Munshi, Laveena
Rochwerg, Bram
Scales, Damon C.
Brodie, Daniel
Thavorn, Kednapa
Kyeremanteng, Kwadwo
Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title_full Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title_fullStr Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title_full_unstemmed Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title_short Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
title_sort long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137509/
https://www.ncbi.nlm.nih.gov/pubmed/32252807
http://dx.doi.org/10.1186/s13054-020-02844-3
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