O3202: The Impact of Race and Ethnicity on Clinical Outcomes in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

Background: Extracorporeal membrane oxygenation, a modified form of cardiopulmonary bypass, is an advanced lifesaving intervention indicated in acute cardiac or pulmonary failure unresponsive to conventional management. Although developments have shown promise in improving survival among critically ill patients, emerging research suggests significant racial/ethnic disparities in subsets of pediatric patients requiring ECMO.
Black race, non-White race, and Hispanic ethnicity are associated with an increased risk of mortality or complications in requiring ECMO to aid in cardiopulmonary resuscitation. Moreover, several studies have identified differences in ECMO utilization and timing by race/ethnicity and insurance status among neonates, patients requiring congenital heart surgery, and patients with cardiomyopathy or myocarditis. Existing literature primarily focuses on pediatric patients receiving ECMO for cardiac pathology, with no known studies describing differences among pediatric patients requiring ECMO. This manuscript aims to evaluate racial/ethnic differences in illness severity and outcomes among all pediatric patients requiring ECMO care at a single urban institution.

Methods: Inclusion criteria included: age < 18, ECMO cannulation at CMC Dallas, and data between 2010-2021. 513 patients met this criteria. For categorization of patient date: lowest pH, PaO2, and PaCO2 in the 6 hours preceding ECMO cannulation in our initial pSOFA calculation. We looked at demographics, pSOFA score, ECMO run characteristics, complications and mortality. We also collected and interpreted data on primary and secondary diagnoses (cardiac, sepsis, pulmonary, immunocompromised, oncologic). We then showed an overall distribution of scores via bar graph, as well as Wilcoxon rank sum and box plot methods.

Results: Our study showed no difference in PSOFA prior to ECMO cannulation by race. We also did not find any difference in median PSOFA among children who survived to ECMO decannulation (11 for survivors vs 10, p=0.34) or survived to ICU discharge (11 for survivors vs 10, p=0.86). Overall, there is no difference in illness severity measured by pSOFA for children cannulated to ECMO. The Wilcoxon rank sum gives a p value of 0.84 for White vs Black,
0.88 for White vs Hispanic, 0.46 for White vs Asian, and 0.12 for White vs all others. This indicates that there is no significant difference among race and baseline pSOFA score. Median scores remained consistent.

Conclusion: This study provides data that our cannulation criteria and clinical presentation of pediatric patients does not vary at CMC Dallas. Overall, there is no difference in illness severity measured by pSOFA for children cannulated to ECMO. To complete this project, we intend to conduct further analysis regarding mortality and ECMO complications by race and ethnicity. Further research should be done to assess if there is a difference in these outcomes by language, zip code, and other socioeconomic factors. Our group will also further stratify data based on gender and age to rule out confounding variables.