Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Extracorporal life support as bridging therapy in Germany
P. Albrecht1, K. Kaier2, C. Möser1, A. Heidenreich1, V. Oettinger1, M. Zehender1, C. von zur Mühlen1, D. Dürschmied3, C. Bode1, P. Stachon3
1Kardiologie & Angiologie I, Albert- Ludwigs-Universität Freiburg, Freiburg im Breisgau; 2Institut für Medizinische Biometrie und Statistik, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau; 3I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim;
Objective: The use of mechanical extracorporeal life support systems (ECLS / ECMO) is a laborious procedure for critically ill patients with increasing use in modern intensive care medicine. The areas of application are diverse and include usage in bridge to recovery as well as bridge to left ventricular assist device (LVAD) or bridge to heart transplantation (HTX). The present study aims to show the ways of usage in clinical practice and the outcomes in different settings.

Methods: All ECMO/ECLS procedures and in-hospital outcomes in Germany between 2007 and 2019 were identified by International Classification of Diseases (ICD-10) and the German Operation and Procedure Classification codes (OPS).

Results: ECLS/ECMO procedures show rising usage in the last years with in 2019 alone 5,000 procedures in german hospitals. In the observed period there are 26,962 procedures in total. A bridging to LVAD took place in 1,638 cases. HTX was performed in 85 patients after usage of ECLS/ECMO. The overall mortality was 64.7%. With LVAD installed the mortality decline to 46.5%. when a HTX took place, the mortality was 16.5%. The most common underlying disease that led to ECLS/ECMO was myocardial infarction in 9,763 cases (36.2%). Bridging to LVAD or HTX cardiomyopathy catches up with rising case numbers (LVAD n=437 (26.7%); HTX n=59 (69.4%)). The mean length of stay in all cases was 24.0 days, rising to 54.7 days when LVAD was installed and 182.9 days with HTX.

Conclusion: The present study shows that mortality is high in patients receiving cardiac support by ECLS/ECMO. ECLS/ECMO as bridge to LVAD or HTX is rarely used in clinical practice but survival is improved if the decision is made for LVAD or HTX.

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