Why the study?
Survival rates for patients on VA-ECMO remain low, and it is unclear whether an ECMO team learning curve benefits patient outcomes.
Does increased institutional experience over time (learning curve) improve survival and morbidity in patients retrieved on VA-ECMO?
Does increased institutional experience over time (learning curve) improve survival and morbidity in patients retrieved on VA-ECMO?
Despite increasing institutional experience with a mobile VA-ECMO retrieval program, mortality and morbidity remained high and unchanged over 7 years, highlighting the critical need for improved patient selection.
Persistent high mortality despite experience cautions against volume-based expansion of VA-ECMO retrieval; leaves open refined selection criteria for trials.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.
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Krasivskyi et al. (2023) studied this question.
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