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Development of the Pediatric Extracorporeal Membrane Oxygenation Prediction Model for Risk-Adjusting Mortality*

Bailly, David K., DO1; Reeder, Ron W., PhD1; Winder, Melissa, NP2; Barbaro, Ryan P., MD3; Pollack, Murray M., MD, MBA4; Moler, Frank W., MD, MS3; Meert, Kathleen L., MD5; Berg, Robert A., MD6; Carcillo, Joseph, MD7; Zuppa, Athena F., MD6; Newth, Christopher, MD, FRACP8; Berger, John, MD4; Bell, Michael J., MD7; Dean, Michael J., MD1; Nicholson, Carol, MD9; Garcia-Filion, Pamela, PhD, MPH10; Wessel, David, MD4; Heidemann, Sabrina, MD5; Doctor, Allan, MD11; Harrison, Rick, MD12; Bratton, Susan L., MD, MPH1; Dalton, Heidi, MD13 for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p 426–434
doi: 10.1097/PCC.0000000000001882
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Objectives: To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes.

Design: Multivariable logistic regression using a large national cohort of pediatric extracorporeal membrane oxygenation patients.

Setting: The ICUs of the eight tertiary care children’s hospitals of the Collaborative Pediatric Critical Care Research Network.

Patients: Five-hundred fourteen children (< 19 yr old), enrolled with an initial extracorporeal membrane oxygenation run for any indication between January 2012 and September 2014.

Interventions: None.

Measurements and Main Results: A total of 514 first extracorporeal membrane oxygenation runs were analyzed with an overall mortality of 45% (n = 232). Weighted logistic regression was used for model selection and internal validation was performed using cross validation. The variables included in the Pediatric Extracorporeal Membrane Oxygenation Prediction model were age (pre-term neonate, full-term neonate, infant, child, and adolescent), indication for extracorporeal membrane oxygenation (extracorporeal cardiopulmonary resuscitation, cardiac, or respiratory), meconium aspiration, congenital diaphragmatic hernia, documented blood stream infection, arterial blood pH, partial thromboplastin time, and international normalized ratio. The highest risk of mortality was associated with the presence of a documented blood stream infection (odds ratio, 5.26; CI, 1.90–14.57) followed by extracorporeal cardiopulmonary resuscitation (odds ratio, 4.36; CI, 2.23–8.51). The C-statistic was 0.75 (95% CI, 0.70–0.80).

Conclusions: The Pediatric Extracorporeal Membrane Oxygenation Prediction model represents a model for predicting in-hospital mortality among children receiving extracorporeal membrane oxygenation support for any indication. Consequently, it holds promise as the first comprehensive pediatric extracorporeal membrane oxygenation risk stratification model which is important for benchmarking extracorporeal membrane oxygenation outcomes across many centers.

1Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT.

2Department of Pediatric Critical Care, Primary Children’s Hospital, Salt Lake City, UT.

3Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.

4Department of Pediatrics, Children’s National Medical Center, Washington, DC.

5Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

6Department of Anesthesia and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA.

7Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA.

8Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

9Trauma and Critical Illness Branch, National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD.

10Department of Biomedical Informatics, Phoenix Children’s Hospital, Phoenix, AZ.

11Departments of Pediatrics and Biochemistry, Washington University, St. Louis, MO.

12Department of Pediatrics, Mattel Children’s Hospital UCLA, Los Angeles, CA.

13Department of Pediatrics, Inova Fairfax Hospital, Fall Church, VA.

*See also p. 490.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063114, and U01HD049934.

Drs. Bailly, Reeder, Pollack, Moler, Meert, Berg, Carcillo, Zuppa, Newth, Berger, Bell, Dean, Garcia-Filion, Wessel, Heidemann, Harrison, and Dalton received support for article research from the National Institutes of Health (NIH). Drs. Reeder’s, Pollack’s, Meert’s, Berger’s, Wessel’s, Heidemann’s, Doctor’s, Harrison’s, and Dalton’s institutions received funding from the NIH. Dr. Barbaro disclosed that he is the Extracorporeal Life Support Organization Registry Chair. Drs. Moler’s, Berg’s, Carcillo’s, Zuppa’s, Newth’s, Bell’s, and Dean’s institutions received funding from the National Institute of Child Health and Human Development. Dr. Moler’s institution also received funding from the National Heart, Lung, and Blood Institute. Dr. Carcillo’s institution also received funding from the National Institute of General Medical Sciences. Dr. Newth received funding from Philips Research North America. Dr. Berger’s institution also received funding from the Association of Pediatric Pulmonary Hypertension and Actelion. Dr. Nicholson disclosed government work. Dr. Doctor’s institution also received funding from the Department of Defense and Kalocyte. Dr. Dalton received funding from Innovative ECMO Concepts (consultant). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: David K. Bailly, DO, Pediatric Cardiac Intensive Care Unit, Division of Critical Care Medicine, Department of Pediatrics, University of Utah, P.O. Box 581289, Salt Lake City, UT 84158-1289. E-mail: David.Bailly@hsc.utah.edu

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies