Procedural Volume and Outcomes of Patients Undergoing VA-ECMO Support

Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. The association between hospital volume of VA-ECMO procedures and outcomes has not been described. The aim of this study was to investigate the association between hospital VA-ECMO procedure volume and outcomes in a large, nationwide registry. 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. During the study period, 10207 VA-ECMO procedures were performed at 223 hospitals; 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) was 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 Cox regression showed an increased 30-day in-hospital mortality at hospitals with the lowest volume category (Hazard Ratio 1.125 (95 % confidence interval 1.049 - 1.203), p = 0.001). However, more complications were observed at hospitals with higher VA-ECMO volume. In this analysis with more than 10000 patients, the majority of implantations was performed at hospitals with the lowest annual volume. Thirty-day in-hospital mortality risk was higher in hospitals with the lowest annual VA-ECMO volume, despite increasing numbers of complications in hospitals with the highest annual VA-ECMO volume.