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Multicenter Study
. 2025 Oct;114(10):1377-1387.
doi: 10.1007/s00392-025-02650-3. Epub 2025 Apr 22.

Clinical use and predictors of outcome in venoarterial extracorporeal membrane (VA ECMO): insights from VERGE (VA ECMO Registry of Germany)

Tobias Wengenmayer #  1 , Dawid L Staudacher #  2 , Alois Philipp  3 , Eike Tigges  4   5 , Angela Dettling  6 , Hendrik Busse  7 , Marc Kriege  8 , Jan-Sören Padberg  9 , Ingo Voigt  10 , Clemens Scherer  11 , Tobias Graf  12 , Dominik Scharpf  13 , Peter Noack  14 , Simone Britsch  15   16   17 , Guido Michels  18 ; VERGE Study Group
Collaborators, Affiliations
Multicenter Study

Clinical use and predictors of outcome in venoarterial extracorporeal membrane (VA ECMO): insights from VERGE (VA ECMO Registry of Germany)

Tobias Wengenmayer et al. Clin Res Cardiol. 2025 Oct.

Abstract

The VA ECMO Registry of Germany (VERGE, http://va-ecmo-register.de/ ) is a prospective, multicenter, investigator-driven registry of Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) all-comers, free from industrial support. VERGE is Germany's first multicenter registry to systematically gather and analyze data from various centers on the clinical use of VA ECMO. This first report compromises data from 581 VA ECMO patients from 2022. Median age was 60 years, hospital survival was 42% and 25% were female. The leading indication for VA ECMO was extracorporeal cardiopulmonary resuscitation (ECPR) followed by VA ECMO in shock (48.9 and 34.9%, respectively). Hospital survival of ECPR was significantly worse compared to shock (28 and 55%, respectively, p < 0.001). Age, pH, and lactate before cannulation all significantly correlated independently with hospital survival (p < 0.001). In VERGE, no patients with pH below 6.7 or lactate above 25 mmol/l survived.

Keywords: Extracorporeal cardiopulmonary resuscitation (ECPR); Extracorporeal membrane oxygenation (ECMO); Outcome; Shock; Survival.

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Conflict of interest statement

Declarations. Conflict of interest: Tobias Wengenmayer is the Deputy Speaker of the German Society of Cardiology's Working Group 42. Guido Michels, Dawid Staudacher, and Eike Tigges are members of the nucleus of Working Group 42 of the German Society of Cardiology.

Figures

Fig. 1
Fig. 1
Indication and outcome of patients in VERGE. (A) shows indication for VA ECMO. Most patients are included either for shock or ECPR. (B) draws the survival according to the indication for VA ECMO. Survival is better in shock and post-cardiotomy than ECPR. The neurological outcome according to the CPC is displayed for ECPR (C) and shock (D). Most surviving patients are discharged with a favorable outcome (CPC 1–2) as shown in green
Fig. 2
Fig. 2
Age and outcome after VA ECMO. (A) shows the age at cannulation for VA ECMO survivors and non-survivors. Survivors were significantly younger. (B) shows a correlation of age at cannulation and survival. There was a significant correlation with worse prognosis in older patients. Age of survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors were younger in both groups, the difference was statistically significant only in shock patients (p = 0.103 and p < 0.001, respectively)
Fig. 3
Fig. 3
Lactate and outcome after VA ECMO. (A) shows hospital survival stratified by lactate before cannulation for VA ECMO. No patient survived with a lactate above 25 mmol/l. (B) Logistic regression of lactate before cannulation and survival. Survival approaches zero asymptotically with increasing lactate levels. Lactate before cannulation in survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors had significantly lower lactate values in both subgroups (both p = 0.001)
Fig. 4
Fig. 4
pH and outcome after VA ECMO. (A) shows hospital survival stratified by pH before cannulation for VA ECMO. No patient survived with a pH below 6.7. (B) Logistic regression of lactate before cannulation and survival. Survival probability shows a sigmoidal shape asymptotically approaching zero survival at low pH levels and 100% survival at high pH levels. pH before cannulation in survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors again had significantly higher pH values in the ECPR subgroup (p < 0.001) but not in shock patients (p = 0.2)
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