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.

Abstract

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.