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

Abstract

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%.

Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study

“…This finding has previously been shown in patients receiving IABP, 26 as well as those receiving other types of MCS, such as ECMO. 15 We found that Impella patients were commonly bridged to VAD, but only a few ultimately received cardiac transplantation, at rates much lower than similar patients receiving ECMO. 15 Lastly, in contrast to patients receiving ECMO, 15 we found that only a minority of patients receiving Impella were discharged to an independent home setting.…”

“…15 We found that Impella patients were commonly bridged to VAD, but only a few ultimately received cardiac transplantation, at rates much lower than similar patients receiving ECMO. 15 Lastly, in contrast to patients receiving ECMO, 15 we found that only a minority of patients receiving Impella were discharged to an independent home setting. Nevertheless, median ''home time'' was relatively high among survivors, suggesting that the majority of these patients are at least able to return to a private residence.…”

“…Finally, given concerns of significant hospital-level costs associated with Impella, 10 we evaluated patientlevel costs both in the short-and long-term. Impella use was associated with significant costs, comparable to ECMO use in Ontario, 15 and IABP use in Europe. 32 The median total costs for patients receiving Impella, while high, are much lower than the 90 th percentile of high-costs for patients in Canadian critical care settings, 33 and are significantly less than other high-cost critical care populations, such as patients with subarachnoid hemorrhage.…”

“…We further identified the presence of complex chronic diseases among our cohort, using previously described methods (eTable 2 available as ESM). [15][16][17] All other conditions were based on the presence of any one inpatient hospital diagnostic code, or two or more outpatient physician billing codes within a two-year period, using relevant International Classification of Diseases (ICD) Version 9 (ICD-9) and ICD-10 codes. Comorbidities identified included history of arrhythmia, history of malignancy, congestive heart failure (CHF), chronic obstructive pulmonary disease, coronary artery disease (CAD), dementia, diabetes mellitus, hypertension, chronic kidney disease, and cerebrovascular disease.…”

Ethik der Reanimation und Entscheidungen am Lebensende

“…Zur Untermauerung unserer Erkenntnisse haben wir sechs systematische [ 164 – 169 ], vier narrative Reviews [ 170 – 173 ] und 13 Beobachtungsstudien [ 76 , 148 , 168 , 174 – 183 ] zu diesem Thema gefunden. Andere Quellen wie Kommentare und ethische Dissertationen wurden als indirekte Informationen angesehen.…”