Procedural volume and outcomes in patients undergoing VA-ECMO support
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Procedural volume and outcomes in patients undergoing VA-ECMO support. / Becher, Peter Moritz; Goßling, Alina; Schrage, Benedikt; Twerenbold, Raphael; Fluschnik, Nina; Seiffert, Moritz; Bernhardt, Alexander M; Reichenspurner, Hermann; Blankenberg, Stefan; Westermann, Dirk.
in: CRIT CARE, Jahrgang 24, Nr. 1, 291, 05.06.2020.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Procedural volume and outcomes in patients undergoing VA-ECMO support
AU - Becher, Peter Moritz
AU - Goßling, Alina
AU - Schrage, Benedikt
AU - Twerenbold, Raphael
AU - Fluschnik, Nina
AU - Seiffert, Moritz
AU - Bernhardt, Alexander M
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Westermann, Dirk
PY - 2020/6/5
Y1 - 2020/6/5
N2 - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. To investigate the association between hospital VA-ECMO procedure volume and outcomes in a large, nationwide registry.METHODS: 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.RESULTS: During the study period, 10,207 VA-ECMO procedures were performed; 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) were 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 logistic regression showed an increased 30-day in-hospital mortality at hospitals with the lowest volume category (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.01-1.27, p = 0.034). Similarly, higher likelihood for complications was observed at hospitals with lower vs. higher annual VA-ECMO volume (adjusted odds ratio 1.46, 95% CI 1.29-1.66, p = 0.001).CONCLUSIONS: In this analysis of more than 10,000 VA-ECMO procedures for cardiogenic shock, the majority of implantations were performed at hospitals with the lowest annual volume. Thirty-day in-hospital mortality and likelihood for complications were higher at hospitals with the lowest annual VA-ECMO volume.
AB - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. To investigate the association between hospital VA-ECMO procedure volume and outcomes in a large, nationwide registry.METHODS: 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.RESULTS: During the study period, 10,207 VA-ECMO procedures were performed; 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) were 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 logistic regression showed an increased 30-day in-hospital mortality at hospitals with the lowest volume category (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.01-1.27, p = 0.034). Similarly, higher likelihood for complications was observed at hospitals with lower vs. higher annual VA-ECMO volume (adjusted odds ratio 1.46, 95% CI 1.29-1.66, p = 0.001).CONCLUSIONS: In this analysis of more than 10,000 VA-ECMO procedures for cardiogenic shock, the majority of implantations were performed at hospitals with the lowest annual volume. Thirty-day in-hospital mortality and likelihood for complications were higher at hospitals with the lowest annual VA-ECMO volume.
KW - Adult
KW - Aged
KW - Analysis of Variance
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Female
KW - Germany
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Odds Ratio
KW - Outcome Assessment, Health Care/methods
KW - Registries/statistics & numerical data
KW - Retrospective Studies
U2 - 10.1186/s13054-020-03016-z
DO - 10.1186/s13054-020-03016-z
M3 - SCORING: Journal article
C2 - 32503646
VL - 24
JO - CRIT CARE
JF - CRIT CARE
SN - 1364-8535
IS - 1
M1 - 291
ER -