Cardiovascular Outcomes Research Laboratory, Division of Cardiac Surgery, and.
Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Pediatrics. 2020 Sep;146(3). doi: 10.1542/peds.2019-3564. Epub 2020 Aug 14.
Extracorporeal life support (ECLS) has been used for >30 years as a life-sustaining therapy in critically ill patients for a variety of indications. In the current study, we aimed to examine trends in use, mortality, length of stay (LOS), and costs for pediatric ECLS hospitalizations.
We performed a retrospective cohort study of pediatric patients (between the ages of 28 days and <21 years) on ECLS using the 2008-2015 National Inpatient Sample, the largest all-payer inpatient hospitalization database generated from hospital discharges. Nonparametric and Cochran-Armitage tests for trend were used to study in-hospital mortality, LOS, and hospitalization costs.
Of the estimated 5847 patients identified and included for analysis, ECLS was required for respiratory failure (36.4%), postcardiotomy syndrome (25.9%), mixed cardiopulmonary failure (21.7%), cardiogenic shock (13.1%), and transplanted graft dysfunction (2.9%). The rate of ECLS hospitalizations increased 329%, from 11 to 46 cases per 100 000 pediatric hospitalizations, from 2008 to 2015 ( < .001). Overall mortality decreased from 50.3% to 34.6% ( < .001). Adjusted hospital costs increased significantly ($214 046 ± 11 822 to 324 841 ± 25 621; = .002) during the study period despite a stable overall hospital LOS (46 ± 6 to 44 ± 4 days; = .94).
Use of ECLS in pediatric patients has increased with substantially improved ECLS survival rates. Hospital costs have increased significantly despite a stable LOS in this group. Dissemination of this costly yet life-saving technology warrants ongoing analysis of use trends to identify areas for quality improvement.
体外生命支持（ECLS）作为一种生命维持疗法，已经在危重病患者中使用了 30 多年，用于多种适应症。在目前的研究中，我们旨在研究儿科 ECLS 住院患者使用趋势、死亡率、住院时间（LOS）和费用。
我们对使用 2008 年至 2015 年全国住院患者样本（由医院出院记录生成的最大的所有支付者住院数据库）的 28 天至<21 岁的儿科患者进行了回顾性队列研究。非参数和 Cochran-Armitage 趋势检验用于研究住院死亡率、LOS 和住院费用。
在估计的 5847 例患者中，确定并纳入分析的患者中，ECLS 用于呼吸衰竭（36.4%）、心脏手术后综合征（25.9%）、混合心肺衰竭（21.7%）、心源性休克（13.1%）和移植移植物功能障碍（2.9%）。ECLS 住院率从 2008 年至 2015 年增加了 329%，从每 100000 名儿科住院患者中 11 例增加到 46 例（<0.001）。总死亡率从 50.3%下降到 34.6%（<0.001）。尽管总体住院 LOS 稳定（46±6 至 44±4 天；=0.94），但研究期间调整后的医院费用显著增加（214046±11822 至 324841±25621；=0.002）。
儿科患者中 ECLS 的使用增加了，ECLS 的生存率显著提高。尽管该组的 LOS 稳定，但医院费用显著增加。这种昂贵但挽救生命的技术的传播需要对使用趋势进行持续分析，以确定质量改进的领域。
