David K Bailly1, Ron W Reeder1, Melissa Winder2, Ryan P Barbaro3, Murray M Pollack4, Frank W Moler3, Kathleen L Meert5, Robert A Berg6, Joseph Carcillo7, Athena F Zuppa6, Christopher Newth8, John Berger4, Michael J Bell7, Michael J Dean1, Carol Nicholson9, Pamela Garcia-Filion10, David Wessel4, Sabrina Heidemann5, Allan Doctor11, Rick Harrison12, Susan L Bratton1, Heidi Dalton13. 1. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT. 2. Department of Pediatric Critical Care, Primary Children's Hospital, Salt Lake City, UT. 3. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 4. Department of Pediatrics, Children's National Medical Center, Washington, DC. 5. Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 6. Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA. 7. Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8. Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 9. Trauma and Critical Illness Branch, National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD. 10. Department of Biomedical Informatics, Phoenix Children's Hospital, Phoenix, AZ. 11. Departments of Pediatrics and Biochemistry, Washington University, St. Louis, MO. 12. Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 13. Department of Pediatrics, Inova Fairfax Hospital, Fall Church, VA.
Abstract
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.
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.
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