Mid-Term Results for Out of Hospital ECLS/ECMO Therapy

Objectives: We report our 4-year results for out of hospital ECLS/ECMO therapy at Bundeswehrzentralkrankenhaus Koblenz.

Methods: Our department started an out of hospital (OOH)-ECLS/ECMO program in 2016 using standardized operating protocols (SOP) and techniques. We recorded data for 48 months. The data was analyzed regarding survival, major complications, length of usage and risk profile. We separated the data in ECLS and the ECMO group and subdivided each group in two subgroups, IN, and OOH group.

Result: From 2016 and 2020, a total of 120 patients were treated with ECLS/ECMO therapy. 63.3% (n = 76) were treated with ECLS and 36.7% (n = 44) with ECMO therapy. 5% (n = 6) of the patients were switched from ECMO to ECLS therapy due to secondary heart failure. 59.2% (n = 71) of patients were male and 40.8% (n = 49) of patients were female. Within the ECMO group, main reason for ECMO therapy was ARDS (n = 40): Within the ECMO group, 70.4% (n = 31) were male and 29.6% (n = 13) were female. Three patients were in need for transfusion after the beginning of the therapy and 2.3% (n = 1) patients with severe obesity had complications due to complicated cannulation procedure with the need for operative repair. Survival in all main and subgroups was 50%. 50% of the patients (n = 22) died. Main cause of death was multiorgan failure with 72.7% (n = 16), 8.2% (n = 4) died due to disseminated intravascular coagulation (DIC), and 9.1% (n = 2) died because of severe interstitial lung diseases (e.g., sarcoidosis, pulmonary fibrosis).

Within the ECLS group, the main reason for ECLS therapy was heart failure due to severe myocardial infarction (n = 66). Within the ECLS group, 52.6% (n = 40) were male and 47.4% (n = 36) were female. 13.2% (n = 10) patients were in need for blood transfusion due to poor condition before the therapy and 3.9% (n = 3) of the patients showed complicated cannulation procedures with need for operative repair or redo: Overall survival within the ECLS group was 55.3% (n = 42), OOH survival was 58.3% (n = 7), and IN survival was 54.7% (n = 35). Overall, 44.7% of the patients (n = 34) died. Main cause of death was multiorgan failure with 58.8% (n = 20), 17.6% (n = 6) died due to DIC, 11.8% (n = 4) died due to sepsis, and 11.8% (n = 4) died because of stroke or intracranial bleeding.

Conclusion: Usage of ECMO/ECLS systems out of hospital is a safe bailout option with acceptable survival. SOP and standardized implantation technique secure efficiency and favors outcome.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021