Procedure Volume and Outcomes in Patients with VA-ECMO Support

Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. Therefore, we investigated the association between hospital volume of VA-ECMO procedures and outcomes in a large dataset.

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 procedural volumes and outcomes as well as complications defined as (bleeding, stroke, abdominal, and limb ischemia).

Results: Of 10,207 VA-ECMO procedures performed at 223 hospitals, acute coronary syndrome was the primary etiology of VA-ECMO implantation (n = 6,202, 60.8%). Mean age was 62 years, 71.2% were male patients with prior CPR in 43.4%. There was a significant association between annualized volume of VA-ECMO procedures and 30-day in-hospital mortality for centers with 0–50, 51–100, and above 100 procedures per center. The majority of implantations (n = 5,421) was performed at hospitals in the lowest volume category (0–50 implantations per year). Interestingly, the number of complications at hospitals with higher number of VA-ECMO procedures were increased.

Conclusion: In a large registry with more than 10,000 patients, major bleeding and ischemic events are the most common complications on VA-ECMO support in Germany. A significant volume-mortality association persists for VA-ECMO procedures. The majority of patients with ECMO support were treated at hospitals with a low procedural volume in Germany. The 30-day in-hospital mortality was lower in high-volume centers (> 50 procedures per year) despite an increased number of complications.

No conflict of interest has been declared by the author(s).