PM1048: Extracorporeal Membrane Oxygenation (ECMO) in Children with Cancer: A National Experience

Background: Extracorporeal Membrane Oxygenation (ECMO) is a resource-intensive, lifesaving form of resuscitation which is infrequently used in pediatric oncology patients. However, given the recent increased use of ECMO in the pediatric population, the experience with ECMO in oncology patients should be updated. We sought to describe healthcare utilization and outcomes in pediatric oncology patients requiring ECMO cannulation.

Methods: We used the Kids Inpatient Database (2019) to identify a cohort of patients admitted with primary diagnosis of malignancy who subsequently underwent ECMO cannulation. This dataset contains a national representative sample of pediatric hospitalizations in the United States. We reported descriptive demographics, and baseline disease information. We then quantified length of stay, total hospitalization charges, and charges per day.

Results: We identified 31 patients with a primary oncology diagnosis who underwent ECMO cannulation. The median age was 7 (IQR 3-16), with 41.9% female patients, and 55.2% white patients. The most common malignancies included acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), and Non-Hodgkins Lymphoma. Children with solid tumors represented 22.5% of children cannulated (7/31). In-hospital mortality was 51.6% (N=16), consistent with overall ECMO outcomes. Of these, 33% were discharged home. Patients were most commonly covered by private insurance (48%) and received care at an urban academic medical center (100%); 35.5% were transferred to the urban academic center where ECMO was performed.. Patients underwent a median of 13 procedures (IQR 11-20) during the ECMO hospitalization. Median hospital charges were $1,302,684 ($705,556-$2,167,772). Median charges per day were $26,887 ($19517-$57066).

Conclusion: ECMO is a lifesaving but resource intensive method of resuscitation. Although ECMO has been infrequently used in pediatric oncology patients, the survival of these patients is consistent with overall outcomes of non-oncology patients. Further studies, including international collaborations, are needed to further investigate indications and outcomes of ECMO cannulation in these patients.