(625) Influenza-Associated Hospitalizations, ECMO Use Before, During, and After H1N1 Pandemic in Children

Introduction: The H1N1 influenza pandemic in 2009 led to increased extracorporeal membrane oxygenation (ECMO) use in children and adults. The objective of our study was to evaluate the demographics, prevalence, complications, and mortality associated with the use of ECMO in hospitalized children with influenza (FLU) from 1997 to 2019

Methods: A retrospective cross-sectional analysis of the Kids’ Inpatient Database (KID) was performed. We grouped the years into 1997-2006 (pre-pandemic), 2009 (pandemic), and 2012-2019 (post-pandemic), excluded neonates, and used univariate analysis and binary logistic regression for inferential statistics. FLU, ECMO, and complications were identified using ICD 9 and 10 codes. Prevalences are presented per 100,000 mid-year, age-specific US population

Results: A total of 208,967 children were hospitalized with FLU during the study period. FLU hospitalization rates in the pre, during, and post-pandemic years were 21.2, 68.7, and 10.4 per 100,000 population, respectively (p < 0.01). A total of 363 children with FLU received ECMO support (0.03 per 100,000 population) with 0.02, 0.11, and 0.03 per 100,000 population during the three periods (p < 0.001). Overall mortality in FLU and ECMO patients was 42.5%, with lower mortality in the post-pandemic vs pandemic period (36.4% vs 53.7%; p=0.018). Complications or organ support documented in ECMO patients including Acute Kidney Injury (AKI) (49%), septic shock (47.8%), chest tube placement (25.8%), hemodialysis (22.2%), ARDS (12.2%), hepatic failure (9.4%), cerebral hemorrhage (7.5%), and tracheostomy (6.9%), were higher in children with FLU on ECMO when compared to non-ECMO cases. On binary regression analysis, AKI, CPR, and sepsis in children with FLU demonstrated higher odds of association with ECMO support. The risk of mortality was highest in the pandemic era (2009). On regression analysis, the risk of mortality was higher with sepsis and during the pandemic era (2009) and when cases with FLU on ECMO developed AKI and lower in the post-pandemic era

Conclusions: The prevalence of FLU hospitalizations, the need for ECMO support, and ECMO-associated mortality were highest during the H1N1 pandemic period. The prevalence of FLU hospitalizations and ECMO-associated mortality has decreased during the post-pandemic period