Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Crit Care. 2020 Apr 6;24(1):131. doi: 10.1186/s13054-020-02844-3.
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.
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.
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).
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.
体外膜肺氧合（ECMO）用于为危重症儿童提供临时心肺支持。虽然已经评估了该人群的短期结果和成本，但对长期生存率和成本的了解较少。
这是一项来自加拿大安大略省的基于人群的队列研究（2009 年 10 月 1 日至 2017 年 3 月 31 日），研究对象为接受 ECMO 的儿科患者（<18 岁），通过使用 ECMO 手术代码进行识别。通过与省级健康数据库的链接确定了结果。主要结果是生存率，测量至出院，以及 ECMO 启动后 1 年、2 年和 5 年。我们评估了 ECMO 后第一年的总患者成本。
我们分析了 342 名儿科患者。ECMO 启动时的平均年龄为 2.9 岁（标准差 [SD] = 5.0）。从住院到 ECMO 启动的中位时间为 5 天（四分位距 [IQR] = 1-13 天）。出院时的总体生存率为 56.4%。1 年、2 年和 5 年的生存率分别为 51.5%、50.0%和 42.1%。幸存者中，99.5%出院回家。所有患者在住院后一年的总费用中位数为 147957 美元（IQR 70571-300295 美元）。其中，大部分归因于入院索引的住院费用（中位数 119197 美元，IQR 57839-250675 美元）。
需要 ECMO 的儿童的院内死亡率仍然很高，但令人欣慰的是，1 年时的长期生存率几乎没有下降。所有患者的中位费用都很高，但主要反映了住院费用，而不是出院后门诊费用。这些信息为提供者和卫生系统提供了价值，允许对短期和长期结果以及儿科 ECMO 幸存者的长期医疗相关费用进行预测。
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