Extracorporeal membrane oxygenation: evolving epidemiology and mortality

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• The epidemiology and mortality trends of extracorporeal membrane oxygenation (ECMO) are not fully understood.
• ECMO is a vital life support technology for severe respiratory and cardiac failure.

Purpose of the Study:

• To investigate the evolving epidemiology and mortality of different ECMO techniques in Germany.
• To analyze trends in venovenous (vv-ECMO), venoarterial (va-ECMO), and pumpless extracorporeal lung assist/interventional lung assist (PECLA/ILA) use and outcomes.

Main Methods:

• Utilized data from the Federal Statistical Office of Germany for patients receiving ECMO outside the operating room between 2007 and 2014.
• Analyzed incidence rates, demographic shifts (increasing proportion of older patients), and in-hospital mortality for various ECMO modalities.

Main Results:

• ECMO utilization (vv-ECMO and va-ECMO) tripled between 2007 and 2012, with PECLA/ILA showing an initial increase followed by a decrease.
• The proportion of older patients receiving ECMO steadily increased during the study period.
• In-hospital mortality decreased over time, reaching 58% for vv-ECMO and 66% for va-ECMO in 2014, but remained high in older patients and within the first 48 hours of use.

Conclusions:

• ECMO use for respiratory and cardiac support in Germany has rapidly increased since 2007, with a recent plateau in vv-ECMO.
• Despite decreasing mortality with increased ECMO utilization, outcomes remain challenging, particularly for elderly individuals and during the critical initial ECMO phase.