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. Methods: Inpatient data from Germany from 2007 to 2018 provided by the Federal Statistical Office of Germany were analysed. The ICD and OPS codes for extracorporeal membrane oxygenation (ECMO) types, acute respiratory distress syndrome (ARDS) and hospital mortality were used. Findings: A total of 45,647 hospitalized patients treated with ECLS were analysed. Overall hospital mortality remains higher than predicted in comparison to the values reported in the literature. The number of VV-ECMO cases increased by 236% percent from 825 in 2005 to 2,768 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. Interpretation: ARDS is a severe disease with a high mortality rate despite ECLS therapy. The mortality rate differs widely in studies such as the CESAR trial and the EOLIA trial and the ELSO Registry in Germany. Funding Statement: This study was supported by internal institutional research funds from the Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt Germany. Declaration of Interests: Dr. Mutlak received lecture fees from GETINGE and conducted workshops for GETINGE. Dr. Friedrichson, Dr. Piekarski and Prof. Zacharowski have no conflicts of interest regarding the article.
Highlights
Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy
Venovenous‐extracorporeal membrane oxygenation (ECMO) The number of VV-ECMO cases increased by 236% from 825 in 2007 to 2768 in 2018
In 2018, the hospital mortality decreased in VV-ECMO patients and VV-ECMO patients with acute respiratory distress syndrome (ARDS) to 53.9% (n = 1493) and 54.4% (n = 926), respectively
Summary
Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy. Various pulmonary and cardiac conditions are indications for the use of ECLS [1]. Different terms are used in the literature for ECLS depending on the system and type of cannulation. ECMO is further classified into venoarterial-ECMO (VA-ECMO) and venovenous-ECMO (VV-ECMO), depending on the support mode. Patients who have undergone lung replacement due to respiratory failure are mainly treated with VV-ECMO, but the cannulation strategy is Friedrichson et al Crit Care (2021) 25:38 often venoarterial (VA) or venovenoarterial (VVA) for patients with combined cardiac and pulmonary failure. VA cannulation is used for cardiac support and is useful for cardiac and cardiosurgical indications as well as for extracorporeal cardiopulmonary resuscitation (E-CPR). The choice of support mode depends largely on the indication. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature
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