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Racial and Ethnic Variation in Pediatric Cardiac Extracorporeal Life Support Survival

Chan, Titus MD, MS, MPP1,2; Di Gennaro, Jane MD, MS2; Farris, Reid W. D. MD, MS2; Radman, Monique MD, MS1,2; McMullan, David Michael MD3

doi: 10.1097/CCM.0000000000002246
Pediatric Critical Care

Objectives: Previous studies have suggested an association between nonwhite race and poor outcomes in small subsets of cardiac surgery patients who require extracorporeal life support. This study aims to examine the association of race/ethnicity with mortality in pediatric patients who receive extracorporeal life support for cardiac support.

Design: Retrospective analysis of registry data.

Setting: Prospectively collected multi-institutional registry data.

Subjects: Data from all North American pediatric patients in the Extracorporeal Life Support International Registry who received extracorporeal life support for cardiac support between 1998 and 2012 were analyzed. Multivariate regression models were constructed to examine the association between race/ethnicity and hospital mortality, adjusting for demographics, diagnosis, pre-extracorporeal life support care, extracorporeal life support variables, and extracorporeal life support-related complications.

Interventions: None.

Measurements and Main Results: Of 7,106 patients undergoing cardiac extracorporeal life support, the majority of patients were of white race (56.9%) with black race (16.7%), Hispanic ethnicity (15.8%), and Asian race (2.8%) comprising the other major race/ethnic groups. The mortality rate was 53.9% (n = 3,831). After adjusting for covariates, multivariate analysis identified black race (relative risk = 1.10; 95% CI, 1.04–1.16) and Hispanic ethnicity (relative risk = 1.08; 95% CI, 1.02–1.14) as independent risk factors for mortality.

Conclusions: Black race and Hispanic ethnicity are independently associated with mortality in children who require cardiac extracorporeal life support.

1The Heart Center, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA.

2Division of Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA.

3Division of Pediatric Cardiac Surgery, Seattle Children’s Hospital, University of Washington, Seattle, WA.

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Dr. Di Gennaro received funding from Seattle Children’s Hospital—Children’s University Medical Group (salary), Academic Enrichment Fund—Seattle Children’s Hospital, and the American Association of Critical Care Nurses (lodging and travel). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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