Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 5;24(1):291.
doi: 10.1186/s13054-020-03016-z.

Procedural volume and outcomes in patients undergoing VA-ECMO support

Peter Moritz Becher  1 , Alina Goßling  2 , Benedikt Schrage  2   3 , Raphael Twerenbold  4 , Nina Fluschnik  2   3 , Moritz Seiffert  2   3 , Alexander M Bernhardt  5 , Hermann Reichenspurner  5 , Stefan Blankenberg  2   3 , Dirk Westermann  6   7
Affiliations

Procedural volume and outcomes in patients undergoing VA-ECMO support

Peter Moritz Becher et al. Crit Care. .

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. To investigate the association between hospital VA-ECMO procedure volume and outcomes in a large, nationwide registry.

Methods: By using administrative data from the German Federal Health Monitoring System, we analyzed all VA-ECMO procedures performed in Germany from 2013 to 2016 regarding the association of procedural volumes with outcomes and complications.

Results: During the study period, 10,207 VA-ECMO procedures were performed; mean age was 61 years, 43.4% had prior CPR, and 71.2% were male patients. Acute coronary syndrome was the primary diagnosis for VA-ECMO implantation (n = 6202, 60.8%). The majority of implantations (n = 5421) were performed at hospitals in the lowest volume category (≤ 50 implantations per year). There was a significant association between annualized volume of VA-ECMO procedures and 30-day in-hospital mortality for centers with lower vs. higher volume per year. Multivariable logistic regression showed an increased 30-day in-hospital mortality at hospitals with the lowest volume category (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.01-1.27, p = 0.034). Similarly, higher likelihood for complications was observed at hospitals with lower vs. higher annual VA-ECMO volume (adjusted odds ratio 1.46, 95% CI 1.29-1.66, p = 0.001).

Conclusions: In this analysis of more than 10,000 VA-ECMO procedures for cardiogenic shock, the majority of implantations were performed at hospitals with the lowest annual volume. Thirty-day in-hospital mortality and likelihood for complications were higher at hospitals with the lowest annual VA-ECMO volume.

Keywords: Complications; Outcomes; Procedure volume; VA-ECMO; Venoarterial extracorporeal membrane oxygenation.

PubMed Disclaimer

Conflict of interest statement

The authors designed the study, analyzed the data, vouch for the data, wrote the paper, and decided to publish. Analysis provided by the Research Data Center of the Federal Bureau of Statistics, Wiesbaden, Germany. All authors have read and approved the manuscript. The manuscript and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible web sites or e-print servers.

Dr. Twerenbold received research support from the Swiss National Science Foundation (P300PB_167803), the University Hospital Basel, the University of Basel, and the Cardiovascular Research Foundation Basel, as well as speaker honoraria/consulting honoraria from Abbott, Brahms, Siemens, Singulex, and Roche.

Dr. Westermann received honorary from Astra-Zeneca, Bayer, BöhringerIngelheim, Berlin-Chemie, and Novartis.

Dr. Schrage received speaker’s fee from AstraZeneca and is currently funded by the German Research Foundation.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
Thirty-day in-hospital mortality of the overall cohort and patients with prior CPR according to annualized hospital volume of VA-ECMO procedures. *p < 0.001: total cohort vs. prior CPR in each category (overall, ≤ 50, > 50–100, > 100). +p < 0.05: ≤ 50 vs. > 50–100, ≤ 50 vs. > 100, > 50–100 vs. > 100 for the total cohort and prior CPR
Fig. 3
Fig. 3
a Thirty-day in-hospital mortality depending on hospital procedure volume during index-hospitalization adjusted for age, sex, prior CPR, indication category, duration of VA-ECMO support, and complications (bleeding, stroke, abdominal ischemia, and limb ischemia). b Association between hospital procedure volume and complications (bleeding, stroke, abdominal ischemia, and limb ischemia) during index-hospitalization adjusted for age, sex, prior CPR, indication category, duration of VA-ECMO support, and time to 30-day in-hospital mortality
See this image and copyright information in PMC

References

    1. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–561. doi: 10.1016/S0140-6736(08)60958-7. - DOI - PubMed
    1. Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care. 2015;19:431. doi: 10.1186/s13054-015-1155-7. - DOI - PMC - PubMed
    1. Lorusso R, Gelsomino S, Parise O, Mendiratta P, Prodhan P, Rycus P, et al. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock in elderly patients: trends in application and outcome from the Extracorporeal Life Support Organization (ELSO) registry. Ann Thorac Surg. 2017;104(1):62–69. doi: 10.1016/j.athoracsur.2016.10.023. - DOI - PubMed
    1. Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36(5):1404–1411. doi: 10.1097/CCM.0b013e31816f7cf7. - DOI - PubMed
    1. Becher P.M.; Schrage BS, C.R.; Schmack, B.; Fluschnik, N.; Schwarzl, M.; Waldeyer, C.; Lindner, D.; Seiffert, M.; Neumann, J.T.; Bernhardt, A.M.; Zeymer, U.; Thiele, H.; Reichenspurner, H.; Blankenberg, S.; Twerenbold, R.; Westermann, D. Venoarterial extracorporeal membrane oxygenation for cardiopulmonary support. Insights From a German Registry. Circulation. 2018;138(20):2298–300. - PubMed