Insight into ECMO, mortality and ARDS: a nationwide analysis of 45,647 ECMO runs

Abstract

Background Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy. The choice of support mode depends largely on the indication. Patients with respiratory failure are predominantly treated with a venovenous (VV) approach. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature Methods Inpatient data from Germany from 2007 to 2018 provided by the Federal Statistical Office of Germany were analysed. The international statistical classification of diseases and related health problems codes (ICD) and process keys (OPS) for extracorporeal membrane oxygenation (ECMO) types, acute respiratory distress syndrome (ARDS) and hospital mortality were used. Results In total, 45,647 hospitalized patients treated with ECLS were analysed. In Germany, 231 hospitals provided ECLS therapy, with a median of 4 VV-ECMO and 9 VA-ECMO in 2018. Overall hospital mortality remained higher than predicted in comparison to the values reported in the literature. The number of VV-ECMO cases increased by 236% from 825 in 2007 to 2768 in 2018. ARDS was the main indication for VV-ECMO in only 33% of the patients in the past, but that proportion increased to 60% in 2018. VA-ECMO support is of minor importance in the treatment of ARDS in Germany. The age distribution of patients undergoing ECLS has shifted towards an older population. In 2018, the hospital mortality decreased in VV-ECMO patients and VV-ECMO patients with ARDS to 53.9% (n = 1493) and 54.4% (n = 926), respectively. Conclusions ARDS is a severe disease with a high mortality rate despite ECLS therapy. Although endpoints and timing of the evaluations differed from those of the CESAR and EOLIA studies and the Extracorporeal Life Support Organization (ELSO) Registry, the reported mortality in these studies was lower than in the present analysis. Further prospective analyses are necessary to evaluate outcomes in ECMO therapy at the centre volume level.

Re: Insight into ECMO, mortality and ARDS: a nationwide analysis of 45,647 ECMO runs (Friedrichson et al., Critical Care, January 2021)

“…There are likely multiple factors explaining the discrepancy between the UK data and the hospital mortality of 54% reported by Friedrichson et al [1]. Firstly, even including neonatal and paediatric patients, 70% of patients receiving VV-ECMO in the German study were aged above 50; for the UK dataset, the corresponding figure was 33%.…”

“…We read with interest the well-conducted analysis presented by Friedrichson et al on the provision of ECMO in Germany from 2007 to 2018 [1].…”

“…Author details 1 Division of Anaesthesia, University of Cambridge, Cambridge, UK. 2 Department of Asthma, Allergy and Lung Biology, King's College London, London, UK.…”

The Implementation and Outcomes of a Nurse-Run Extracorporeal Membrane Oxygenation Program, a Retrospective Single-Center Study

“…More patients were placed on venovenous-ECMO during nurse-run ECMO (year 2018 and 2019), which also has higher historical survival rates than venoarterial-ECMO, although we also accounted for the type of ECMO configuration in our analysis. Patients with acute respiratory distress syndrome on venovenous-ECMO had a survival rate of 63% in the Extracorporeal Membrane Oxygenation to Rescue Lung Injury in Severe Acute Respiratory Distress Syndrome trial, and 54% in a large retrospective cohort study from Germany ( 2 , 10 , 15 ).…”

Circulating miRNAs as Promising Biomarkers to Evaluate ECMO Treatment Responses in ARDS Patients

“…Despite a recent randomized clinical trial [ 5 ], its efficacy and benefits are still questioned. Indeed, the mortality rates are very variable [ 2 , 6 , 7 , 8 ], and it has been highlighted that an appropriate patient selection and experience in ECMO management are the keys for successful treatment [ 9 ].…”