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Extracorporeal membrane oxygenation: evolving epidemiology and mortality

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Abstract

Purpose

The evolution of the epidemiology and mortality of extracorporeal membrane oxygenation (ECMO) remains unclear. The present study investigates the evolving epidemiology and mortality of various ECMO techniques in Germany over time, used for both severe respiratory and cardiac failure.

Methods

Data on all patients receiving venovenous (vv-ECMO) and venoarterial (va-ECMO) ECMO as well as pumpless extracorporeal lung assist/interventional lung assist (PECLA/ILA) outside the operating room in Germany from 1 January 2007 through 31 December 2014 were obtained from the Federal Statistical Office of Germany and analyzed.

Results

The incidence of vv-ECMO and va-ECMO in the population increased threefold from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and from 0.1:100,000 in 2007 to 0.7:100,000 in 2012 and to a maximum of 3.5:100,000 in 2014, respectively. The incidence of arteriovenous PECLA/ILA also increased from 0.4:100,000 to a maximum of 0.6:100,000 in 2011, but decreased thereafter to 0.3:100,000 in 2014. The relative proportion of older patients receiving ECMO is steadily increasing. In-hospital mortality decreased over time and reached 58 and 66 % for vv-ECMO and va-ECMO in 2014, respectively. In addition, mortality steadily increased with age and was especially high in the first 48 h of ECMO use.

Conclusions

In a high-income country like Germany, the use of ECMO has been rapidly increasing since 2007 for both respiratory and cardiac support, with a recent plateau in vv-ECMO use. In-hospital mortality decreased with increasing ECMO utilization, but remains high, especially in older patients and in the first 48 h of use.

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Abbreviations

ECCO2R:

Extracorporeal CO2 removal

ECMO:

Extracorporeal membrane oxygenation

vv-ECMO:

Venovenous extracorporeal membrane oxygenation

va-ECMO:

Venoarterial extracorporeal membrane oxygenation

IABP:

Intra-aortic balloon pumping

PECLA/ILA:

Pumpless extracorporeal lung assist/interventional lung assist

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Acknowledgments

We thank the Federal Statistical Office of Germany (Statistisches Bundesamt, Wiesbaden, Germany) for their excellent support.

Author information

Authors and Affiliations

  1. Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Christian Karagiannidis, Stephan Strassmann & Wolfram Windisch

  2. Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA

    Daniel Brodie

  3. Department of Thoracic Surgery, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Erich Stoelben

  4. Department of Cardiothoracic Surgery, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Alois Philipp

  5. Department of Anesthesiology and Critical Care Medicine, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Thomas Bein

  6. Department of Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Thomas Müller

Authors
  1. Christian Karagiannidis
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  2. Daniel Brodie
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  3. Stephan Strassmann
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  4. Erich Stoelben
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  5. Alois Philipp
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  7. Thomas Müller
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Corresponding author

Correspondence to Christian Karagiannidis.

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Conflicts of interest

C.K. received travel grants, lecture fees and performs consultant services for Maquet, Rastatt, Germany; D.B. is on the Medical Advisory Boards for ALung Technologies and Kadence. All compensation for these activities goes to Columbia University. S.S. received travel grants and lecture fees from Maquet Cardiopulmonary, Rastatt, Germany, E.S. has no conflicts of interest, A.P. received travel grants from Maquet Cardiopulmonary, Rastatt, Germany, T.B. received honoraria for lectures and activities as member of the advisory board of Novalung, Heilbronn, Germany, T.M. received travel support for invited lectures from Maquet Cardiopulmonary, Rastatt, Germany; W.W. received fees for advisory board meetings and lectures from Maquet Cardiopulmonary, Rastatt, Germany. C.K. and W.W. received an open research grant for the hospital from Maquet Cardiopulmonary, Rastatt, Germany.

Additional information

Take-home message: The current study shows, for the first time, recent epidemiological data of ECMO utilization and associated mortality in a high-income country. This real-world data suggests that, although mortality decreased with increasing experience, it remained high in both venovenous and venoarterial ECMO.

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Karagiannidis, C., Brodie, D., Strassmann, S. et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 42, 889–896 (2016). https://doi.org/10.1007/s00134-016-4273-z

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