The effect of merging two quaternary hospitals on ecpr outcomes

Abstract

AIMS & OBJECTIVES: To describe the impact of merging two Pediatric intensive care units (PICUs) on the overall and neurocognitive outcomes of children who received extracorporeal cardiopulmonary resuscitation (ECPR) and identify which factors influence these outcomes. METHODS: Retrospective chart review of patients requiring ECPR during their inpatient management between 2008 and 2019 by the Queensland Pediatric Cardiac Service was performed. In 2014 two tertiary Children's Hospitals merged to form the Queensland Children's Hospital (QCH). The results from three time periods (2008-14: pre-merge, 2014-17: first years post merge and 2018-2019: established merge) were compared. Primary study outcomes were survival to hospital discharge and favorable neurological outcome at hospital discharge defined as Pediatric Cerebral Performance Categories (PCPC) ≤ 3. RESULTS: Of 70 children, (median age 2.68 months [IQR 13.42]) who met inclusion criteria, 44 (62.9%) survived to discharge and 38 (86.4% of survivors) had a good neurocognitive outcome. Merging the hospitals led to a temporary trend of poorer outcomes immediately following the merge. Once established at the new hospital the number of ECPR runs/year increased, and there was a trend to both a reduced arrest-to-flow duration and improved overall outcome. On multivariate analysis of the entire cohort, only longer time to clear lactate was associated with mortality (OR: 0.47,p<0.05: Adjusted OR:0.49, p < 0.05). The only factor impacting neurological outcome was initial pH ≥ 7.0 (OR: 3.01, 9% CI: 1.09-8.67, P < 0.05). CONCLUSIONS: Merging two hospitals temporarily resulted in a temporary, reversible trend to poorer survival and neurological outcome in pediatric patients requiring ECPR.L6347728172021-04-21 <br />