Beyond survival: Readmissions and late mortality in pediatric ECMO survivors

Introduction: The objective of our study was to identify rates of readmission and late mortality in pediatric extracorporeal membrane oxygenation (ECMO) patients after discharge from their ECMO hospitalization. Methods: We conducted a population-based retrospective cohort study of children who were discharged after ECMO. Data were obtained from the State Inpatient Databases for 10 states. Time-to-event analyses were used to estimate the risk of readmission and to identify factors predictive of readmission and late mortality, including characteristics of initial hospital course and ECMO center volume. Results: A total of 1603 pediatric ECMO patients were identified, and 42.4% of these patients died prior to discharge. Of the 924 ECMO survivors, 35.6% had an unplanned readmission, and 3% died during readmission within 1 year. The risk of readmission was significantly related to the indication for ECMO, number of complex chronic conditions, transfer status, and discharge destination (all p < 0.05). The risk of late mortality was significantly related to health insurance, transfer status, number of complex chronic conditions, and indication for ECMO (all p < 0.05). Conclusions: Pediatric ECMO survivors have a high risk of hospital readmission with approximately 3% mortality during readmissions within 1 year of initial discharge.