Post-ECMO chest tube placement: A propensity score-matched survival analysis

Abstract

Background: Severe morbidity and mortality has been reported from chest tube (CT) placement during pediatric extracorporeal membrane oxygenation (ECMO).

Methods: Kids' Inpatient Database (KID) was analyzed for ECMO with CT placed <8days postcannulation (1997-2009).

Results: Overall, 5884 patients were identified (213 CT) (56% male, 49% white), with a median (IQR) age at ECMO cannulation 7 (117)days, length of stay (LOS) 26 (35)days, and total charges (TC) 342,116 (409,573) USD. Diagnoses included congenital diaphragmatic hernia (CDH) 16%, meconium aspiration (MA) 2%, pulmonary hypertension (PH) 13%, respiratory distress syndrome (RDS) 41%, and cardiac (C) 29%. Survival was overall 57%, CDH 47%, MA 88%, PH 75%, RDS 57%, and C 52%. There were no differences in survival between CT and non-CT patients compared overall, or by diagnosis, or by age <30days, or by diagnosis and age <30days. Multivariate analysis and propensity score matching for all ages, or <30days of age by diagnosis showed no difference in survival between CT and non-CT patients.

Conclusion: Analysis of KID with correlative propensity score matching demonstrates no increased mortality in pediatric ECMO patients requiring CT placement.

Keywords: Chest tubes; Extracorporeal membrane oxygenation; Outcomes research; Thoracostomy.