On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018—An Analysis of the Extracorporeal Life Support Organization Registry

Martina A. Steurer, MD, MAS; Joseph E. Tonna, MD, MS; Garrett N. Coyan, MD, MS; Sarah Burki, MD; Christopher M. Sciortino, MD, PhD; Peter E. Oishi, MD

doi:10.1097/CCE.0000000000000698

Critical Care Explorations (May 2022)

On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018—An Analysis of the Extracorporeal Life Support Organization Registry

Martina A. Steurer, MD, MAS,
Joseph E. Tonna, MD, MS,
Garrett N. Coyan, MD, MS,
Sarah Burki, MD,
Christopher M. Sciortino, MD, PhD,
Peter E. Oishi, MD

Affiliations

Martina A. Steurer, MD, MAS: 1 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
Joseph E. Tonna, MD, MS: 3 Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health; Salt Lake City, UT.
Garrett N. Coyan, MD, MS: 5 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA.
Sarah Burki, MD: 5 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA.
Christopher M. Sciortino, MD, PhD: 5 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA.
Peter E. Oishi, MD: 1 Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.

DOI: https://doi.org/10.1097/CCE.0000000000000698
Journal volume & issue: Vol. 4, no. 5
p. e0698

Abstract

Read online

OBJECTIVES:. We aimed to investigate whether there are differences in outcome for pediatric patients when extracorporeal life support (ECLS) is initiated on-hours compared with off-hours. DESIGN:. Retrospective cohort study. SETTING:. Ten-year period (2009–2018) in United States centers, from the Extracorporeal Life Support Organization registry. PATIENTS:. Pediatric (>30 d and <18 yr old) patients undergoing venovenous and venoarterial ECLS. INTERVENTIONS:. The primary predictor was on versus off-hours cannulation. On-hours were defined as 0700–1859 from Monday to Friday. Off-hours were defined as 1900–0659 from Monday to Thursday or 1900 Friday to 0659 Monday or any time during a United States national holiday. The primary outcome was inhospital mortality. The secondary outcomes were complications related to ECLS and length of hospital stay. MEASUREMENTS AND MAIN RESULTS:. In a cohort of 9,400 patients, 4,331 (46.1%) were cannulated on-hours and 5,069 (53.9%) off-hours. In the off-hours group, 2,220/5,069 patients died (44.0%) versus 1,894/4,331 (44.1%) in the on-hours group (p = 0.93). Hemorrhagic complications were lower in the off-hours group versus the on-hours group (hemorrhagic 18.4% vs 21.0%; p = 0.002). After adjusting for patient complexity and other confounders, there were no differences between the groups in mortality (odds ratio [OR], 0.95; 95% CI, 0.85–1.07; p = 0.41) or any complications (OR, 1.02; 95% CI, 0.89–1.17; p = 0.75). CONCLUSIONS:. Survival and complication rates are similar for pediatric patients when ECLS is initiated on-hours compared with off-hours. This finding suggests that, in aggregate, the current pediatric ECLS infrastructure in the United States provides adequate capabilities for the initiation of ECLS across all hours of the day.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

About the journal