Background Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1–13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571–$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839–$250,675). Conclusions Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.

中文翻译：

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危重儿童体外膜肺氧合后的长期生存率和成本——一项基于人群的队列研究

背景 体外膜肺氧合 (ECMO) 用于为危重儿童提供临时心肺支持。虽然已经在该人群中评估了短期结果和成本，但对长期生存率和成本知之甚少。方法 加拿大安大略省（2009 年 10 月 1 日至 2017 年 3 月 31 日）接受 ECMO 的儿科患者（<18 岁）的基于人群的队列研究，通过使用 ECMO 程序代码确定。通过与省级卫生数据库的链接确定结果。主要结果是生存率，测量到出院，以及 ECMO 启动后 1 年、2 年和 5 年。我们评估了 ECMO 后第一年的患者总费用。结果 我们分析了 342 名儿科患者。ECMO 启动时的平均年龄为 2 岁。9 年（标准偏差 [SD] = 5.0）。从入院到启动 ECMO 的中位时间为 5 天（四分位距 [IQR] = 1-13 天）。出院的总生存率为 56.4%。1 年、2 年和 5 年的生存率分别为 51.5%、50.0% 和 42.1%。在幸存者中，99.5% 的人出院回家。所有患者入院后一年的总费用中位数为 147,957 美元（IQR 70,571-300,295 美元）。在这些费用中，很大一部分归因于指数入院的住院费用（中位数为 119,197 美元，IQR 为 57,839-250,675 美元）。结论 需要 ECMO 的儿童仍然具有显着的院内死亡率，但令人欣慰的是，1 年的长期生存率几乎没有下降。所有患者的中位费用都很高，但主要反映住院费用，而不是出院后的门诊费用。这些信息为提供者和卫生系统提供了价值，可以预测短期和长期结果，以及儿科 ECMO 幸存者的长期医疗相关费用。