(859) Prolonged Pediatric ECMO: Reviewing Pediatric Health Information System Data Trends, 2015-2023

Introduction: Prolonged courses of extracorporeal membrane oxygenation (ECMO), commonly defined as greater than or equal to 21 days, have increased in prevalence among adults without clear association between duration and overall survival. In children, older multi-institutional data suggest prolonged ECMO is associated with increased mortality. However, few recent reports of epidemiology and outcomes of prolonged pediatric ECMO exist.

Methods: With IRB approval, we queried the Pediatric Health Information System (PHIS) database for children admitted to an ICU between 2015 and 2023 treated with ECMO. PHIS is an administrative database of billing codes from the Children’s Hospital Association. Demographics, diagnoses, resources used during PICU admission, and outcomes are compared between patients on prolonged ECMO (>21 days) and shorter runs using Wilcoxon rank-sum tests (continuous variables; shown as median [IQR]) and Chi-squared tests (categorical variables). PICU free days (PFD) were calculated by subtracting PICU length of stay (LOS) from 90; non-survivors and those with LOS >90d were assigned zero PFDs. Patients on prolonged ECMO as a proportion of each year’s population were analyzed with simple linear regression, reported as regression coefficient based on 95% CI.

Results: Among 17,878 ECMO patients, 1009 (5.6%) were on ECMO for >21 days, 52% were male, 53% white, and 56% publicly insured. The median duration of prolonged ECMO support was 30 (24-42) days. Prolonged ECMO patients were younger (3 [0-58] vs 5 [0-95] months, p< 0.001), but other demographics did not significantly differ. Prolonged ECMO had unfavorable clinical outcomes: increased mortality (62% v 27%, p< 0.001) and hospital LOS (73 [42-136] vs 27 [9-62] days, p< 0.001), and fewer PFDs (0 [0-0] vs 69 [0-87], p< 0.001). Prolonged runs accounted for 7.2% of ECMO runs in 2015 and 4.5% in 2023 with no significant change over time (coefficient: -0.0015, p=0.14).

Conclusions: In this dataset from 46 academic children’s hospitals, the rate of prolonged ECMO cases has remained stable in recent years with more than one-third of children surviving, yet mortality remains comparatively higher. Further research to determine which patients benefit from prolonged ECMO and what adjunctive treatments improve outcomes is needed.