Trends in Mortality and Costs of Pediatric Extracorporeal Life Support

BACKGROUND: 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. METHODS: 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. RESULTS: 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 (P. 001). Overall mortality decreased from 50. 3% to 34. 6% (P. 001). Adjusted hospital costs increased significantly (214 046 ± 11 822 to 324 841 ± 25 621; P =. 002) during the study period despite a stable overall hospital LOS (46 ± 6 to 44 ± 4 days; P =. 94). CONCLUSIONS: 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.