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J Pediatr Intensive Care
DOI: 10.1055/s-0044-1800965
Original Article

Characterizing Pediatric ECMO Outcomes and Access: A State-Wide Analysis in New South Wales, Australia

Katie M. Moynihan
1   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States
3   Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
4   Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts, United States
,
Francisco J. Schneuer
5   Clinical and Population Translational Health, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
,
Marino Festa
6   New South Wales Kids ECMO Referral Service, Australia
7   Kids Critical Care Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Shreerupa Basu
1   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States
7   Kids Critical Care Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Nitesh Singhal
7   Kids Critical Care Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Matthew Liava'a
8   Cardiothoracic Surgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Hari Ravindranathan
9   Children's Intensive Care Unit, Sydney Children's Hospital, Randwick, Australia
,
Natasha Nassar
5   Clinical and Population Translational Health, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
› Author Affiliations Funding This work and N.N. are supported by the Australian National Health and Medical Research Council (NHMRC, approval no.: APP1197940) and Financial Markets Foundation for Children. The funders did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Abstract

This study examines impacts of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) (1) outcomes and (2) utilization. This is a state-wide retrospective study of children (≤15 years) in New South Wales (NSW), Australia (2002–2020). ECMO-supported patients were identified from NSW Admitted Patient Data Collection, with diagnoses defined using International Classification of Diseases version 10-Australian Modification codes. SDoH included socio-economic indexes for area index of social disadvantage (quintiles), residence (metropolitan-Sydney vs. regional/remote), and insurance. Survival analyses assessed associations with SDoH and clinical characteristics, with multivariable analyses restricted to cardiac patients. For utilization analyses, children with equivalent diagnoses and no comorbid contraindications who died without ECMO comprised the comparative cohort. Of 267 ECMO runs, (238 in 229 NSW residents) its use increased over time. Cardiac indications predominated (84%) with 43% in neonates and 19% in unplanned admissions. Overall, 96% were Australian-born and 76% from metropolitan-Sydney. For outcomes, 36% of deaths occurred in-hospital, with 58% of patients alive at study conclusion (median follow-up: 1.3 [interquartile range: 0–6.2] years). Higher mortality was observed in the neonatal age group, and diaphragmatic hernia diagnoses, while respiratory failure was associated with lower mortality (log-rank p < 0.05). There was no association between mortality in children supported on ECMO and SDoH (p > 0.05). Considering utilization, patients who died without ECMO were more likely to live in regional/remote/under-resourced areas and have public insurance versus ECMO-supported children. Population-standardized ECMO rates were similar by SDoH. We identified disparate ECMO utilization but equivalent outcomes according to SDoH. Data support ongoing commitment to developing approaches that promote equitable access to life-saving therapies across demographic and geographic barriers.

Keywords

children - retrospective study - extracorporeal membrane oxygenation - New South Wales - social determinants of health - Australia - survival analysis

Note

Data sharing statement underlying data used is protected by confidentiality agreements and cannot be shared.


Supplementary Material



Publication History

Received: 15 April 2024

Accepted: 30 October 2024

Article published online:
26 December 2024

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