National trends in neonatal extracorporeal membrane oxygenation in the United States

Objective To determine trends in neonatal extracorporeal membrane oxygenation (ECMO) utilization from 2002-2011. Study design Using the Nationwide inpatient sample (NIS), we conducted a population-based retrospective cohort study to identify ECMO utilization among neonates. Incidence of ECMO utilization, length of stay (LOS), cost and mortality were estimated. Result In all, 33,367,146 neonates were identified of which 7603 (18 per 100,000 live births) underwent ECMO. Neonatal ECMO increased from 12 to 23 runs per 100,000 live births. Mortality was 48.4%, decreasing from 47.5 to 41.9% between 2002 and 2011. On multivariate analysis, mortality was significantly higher for infectious indications (OR 4.1; CI 1.1-16.0), E-CPR (OR 3.8; CI 1.4-10.7) and cardiac indications (OR 2.0; CI 1.5-2.8). On hierarchical regression, LOS increased by 1.6 days each year (p = 0.02) and cost of hospitalization increased by $14,033 each year (p < 0.0001). Conclusion Neonatal ECMO utilization increased, while mortality decreased during the study period. These findings suggest an improvement in neonatal ECMO care.