Intensive Care Medicine

, Volume 42, Issue 5, pp 889–896 | Cite as

Extracorporeal membrane oxygenation: evolving epidemiology and mortality

  • Christian KaragiannidisEmail author
  • Daniel Brodie
  • Stephan Strassmann
  • Erich Stoelben
  • Alois Philipp
  • Thomas Bein
  • Thomas Müller
  • Wolfram Windisch



The evolution of the epidemiology and mortality of extracorporeal membrane oxygenation (ECMO) remains unclear. The present study investigates the evolving epidemiology and mortality of various ECMO techniques in Germany over time, used for both severe respiratory and cardiac failure.


Data on all patients receiving venovenous (vv-ECMO) and venoarterial (va-ECMO) ECMO as well as pumpless extracorporeal lung assist/interventional lung assist (PECLA/ILA) outside the operating room in Germany from 1 January 2007 through 31 December 2014 were obtained from the Federal Statistical Office of Germany and analyzed.


The incidence of vv-ECMO and va-ECMO in the population increased threefold from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and from 0.1:100,000 in 2007 to 0.7:100,000 in 2012 and to a maximum of 3.5:100,000 in 2014, respectively. The incidence of arteriovenous PECLA/ILA also increased from 0.4:100,000 to a maximum of 0.6:100,000 in 2011, but decreased thereafter to 0.3:100,000 in 2014. The relative proportion of older patients receiving ECMO is steadily increasing. In-hospital mortality decreased over time and reached 58 and 66 % for vv-ECMO and va-ECMO in 2014, respectively. In addition, mortality steadily increased with age and was especially high in the first 48 h of ECMO use.


In a high-income country like Germany, the use of ECMO has been rapidly increasing since 2007 for both respiratory and cardiac support, with a recent plateau in vv-ECMO use. In-hospital mortality decreased with increasing ECMO utilization, but remains high, especially in older patients and in the first 48 h of use.


Extracorporeal membrane oxygenation Extracorporeal carbon dioxide removal Epidemiology Indication Technical development 



Extracorporeal CO2 removal


Extracorporeal membrane oxygenation


Venovenous extracorporeal membrane oxygenation


Venoarterial extracorporeal membrane oxygenation


Intra-aortic balloon pumping


Pumpless extracorporeal lung assist/interventional lung assist



We thank the Federal Statistical Office of Germany (Statistisches Bundesamt, Wiesbaden, Germany) for their excellent support.

Compliance with ethical standards

Conflicts of interest

C.K. received travel grants, lecture fees and performs consultant services for Maquet, Rastatt, Germany; D.B. is on the Medical Advisory Boards for ALung Technologies and Kadence. All compensation for these activities goes to Columbia University. S.S. received travel grants and lecture fees from Maquet Cardiopulmonary, Rastatt, Germany, E.S. has no conflicts of interest, A.P. received travel grants from Maquet Cardiopulmonary, Rastatt, Germany, T.B. received honoraria for lectures and activities as member of the advisory board of Novalung, Heilbronn, Germany, T.M. received travel support for invited lectures from Maquet Cardiopulmonary, Rastatt, Germany; W.W. received fees for advisory board meetings and lectures from Maquet Cardiopulmonary, Rastatt, Germany. C.K. and W.W. received an open research grant for the hospital from Maquet Cardiopulmonary, Rastatt, Germany.

Supplementary material

134_2016_4273_MOESM1_ESM.pdf (3.6 mb)
Supplementary material 1 (PDF 3676 kb)


  1. 1.
    Brodie D, Bacchetta M (2011) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–1914CrossRefPubMedGoogle Scholar
  2. 2.
    Fagnoul D, Combes A, De Backer D (2014) Extracorporeal cardiopulmonary resuscitation. Curr Opin Crit Care 20:259–265CrossRefPubMedGoogle Scholar
  3. 3.
    Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Brechot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–846CrossRefPubMedGoogle Scholar
  4. 4.
    Muller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede CE, Zimmermann M, Birnbaum D, Schmid C, Riegger GA, Pfeifer M (2009) Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. Eur Respir J 33:551–558CrossRefPubMedGoogle Scholar
  5. 5.
    Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, CESAR trial collaboration (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363CrossRefPubMedGoogle Scholar
  6. 6.
    Pham T, Combes A, Roze H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard JC, Brun-Buisson C, Brochard L, REVA Research Network (2013) Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med 187:276–285CrossRefPubMedGoogle Scholar
  7. 7.
    New Zealand Australia Extracorporeal Membrane Oxygenation Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettila V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M (2009) Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 302:1888–1895CrossRefGoogle Scholar
  8. 8.
    Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, Ranieri VM, Gattinoni L, Landoni G, Holzgraefe B, Beutel G, Zangrillo A, Italian ECMOnet (2013) Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score. Intensive Care Med 39:275–281CrossRefPubMedGoogle Scholar
  9. 9.
    Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, Iotti GA, Arcadipane A, Panarello G, Ranieri VM, Terragni P, Antonelli M, Gattinoni L, Oleari F, Pesenti A (2011) The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 37:1447–1457CrossRefPubMedGoogle Scholar
  10. 10.
    Karagiannidis C, Strassmann S, Philipp A, Muller T, Windisch W (2015) Veno-venous extracorporeal CO2 removal improves pulmonary hypertension in acute exacerbation of severe COPD. Intensive Care Med 41:1509–1510CrossRefPubMedGoogle Scholar
  11. 11.
    Karagiannidis C, Kampe KA, Sipmann FS, Larsson A, Hedenstierna G, Windisch W, Mueller T (2014) Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations. Crit Care 18:R124CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Abrams D, Roncon-Albuquerque R Jr, Brodie D (2015) What’s new in extracorporeal carbon dioxide removal for COPD? Intensive Care Med 41:906–908CrossRefPubMedGoogle Scholar
  13. 13.
    Del Sorbo L, Pisani L, Filippini C, Fanelli V, Fasano L, Terragni P, Dell’Amore A, Urbino R, Mascia L, Evangelista A, Antro C, D’Amato R, Sucre MJ, Simonetti U, Persico P, Nava S, Ranieri VM (2015) Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med 43:120–127CrossRefPubMedGoogle Scholar
  14. 14.
    Sauer CM, Yuh DD, Bonde P (2015) Extracorporeal membrane oxygenation use has increased by 433 % in adults in the United States from 2006 to 2011. ASAIO J 61:31–36CrossRefPubMedGoogle Scholar
  15. 15.
  16. 16.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Bohm M, Ebelt H, Schneider S, Werdan K, Schuler G, Intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial investigators (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382:1638–1645CrossRefPubMedGoogle Scholar
  17. 17.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebelt H, Schneider S, Schuler G, Werdan K, IABP-SHOCK II Trial Investigators (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296CrossRefPubMedGoogle Scholar
  18. 18.
    Lorusso R, Centofanti P, Gelsomino S, Barili F, Di Mauro M, Orlando P, Botta L, Milazzo F, Actis Dato G, Casabona R, Casali G, Musumeci F, De Bonis M, Zangrillo A, Alfieri O, Pellegrini C, Mazzola S, Coletti G, Vizzardi E, Bianco R, Gerosa G, Massetti M, Caldaroni F, Pilato E, Pacini D, Di Bartolomeo R, Marinelli G, Sponga S, Livi U, Mauro R, Mariscalco G, Beghi C, Miceli A, Glauber M, Pappalardo F, Russo CF, GIROC Investigators (2016) Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: a 5-year multi-institutional experience. Ann Thorac Surg 101:919–926Google Scholar
  19. 19.
    Muller G, Flecher E, Lebreton G, Luyt CE, Trouillet JL, Brechot N, Schmidt M, Mastroianni C, Chastre J, Leprince P, Anselmi A, Combes A (2016) The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 42:370–378Google Scholar
  20. 20.
    Abrams D, Combes A, Brodie D (2014) What’s new in extracorporeal membrane oxygenation for cardiac failure and cardiac arrest in adults? Intensive Care Med 40:609–612CrossRefPubMedGoogle Scholar
  21. 21.
    Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411CrossRefPubMedGoogle Scholar
  22. 22.
    Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561CrossRefPubMedGoogle Scholar
  23. 23.
    Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M, Higashi A, Itakura K, Sera A, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S (2012) Should we emergently revascularize occluded coronaries for cardiac arrest?: rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation 126:1605–1613CrossRefPubMedGoogle Scholar
  24. 24.
    Camboni D, Philipp A, Lubnow M, Bein T, Haneya A, Diez C, Schmid C, Muller T (2011) Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 40:1341–1346 (discussion 1341–1347)PubMedGoogle Scholar
  25. 25.
    Weber-Carstens S, Goldmann A, Quintel M, Kalenka A, Kluge S, Peters J, Putensen C, Muller T, Rosseau S, Zwissler B, Moerer O (2013) Extracorporeal lung support in H1N1 provoked acute respiratory failure: the experience of the German ARDS Network. Dtsch Arztebl Int 110:543–549PubMedPubMedCentralGoogle Scholar
  26. 26.
    Ventetuolo CE, Muratore CS (2014) Extracorporeal life support in critically ill adults. Am J Respir Crit Care Med 190:497–508CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Schmidt M, Zogheib E, Roze H, Repesse X, Lebreton G, Luyt CE, Trouillet JL, Brechot N, Nieszkowska A, Dupont H, Ouattara A, Leprince P, Chastre J, Combes A (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39:1704–1713CrossRefPubMedGoogle Scholar
  28. 28.
    Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, Cooper DJ, Brodie D, Pellegrino V, Combes A, Pilcher D (2014) Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score. Am J Respir Crit Care Med 189:1374–1382CrossRefPubMedGoogle Scholar
  29. 29.
    Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, Annich GM (2015) Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med 191:894–901CrossRefPubMedGoogle Scholar
  30. 30.
    Enger T, Philipp A, Videm V, Lubnow M, Wahba A, Fischer M, Schmid C, Bein T, Muller T (2014) Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care 18:R67CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Combes A, Brodie D, Bartlett R, Brochard L, Brower R, Conrad S, De Backer D, Fan E, Ferguson N, Fortenberry J, Fraser J, Gattinoni L, Lynch W, MacLaren G, Mercat A, Mueller T, Ogino M, Peek G, Pellegrino V, Pesenti A, Ranieri M, Slutsky A, Vuylsteke A, International ECMO Network (ECMONet) (2014) Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med 190:488–496CrossRefPubMedGoogle Scholar
  32. 32.
    Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38:1647–1653CrossRefPubMedGoogle Scholar
  33. 33.
    Thattil R, Klepzig D, Schuster M (2012) Intensive care capacities in Germany: provision and usage between 1991 and 2009. Anaesthesist 61:56–62CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbHWitten/Herdecke University HospitalCologneGermany
  2. 2.Division of Pulmonary, Allergy and Critical CareColumbia University College of Physicians and Surgeons/New York-Presbyterian HospitalNew YorkUSA
  3. 3.Department of Thoracic Surgery, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbHWitten/Herdecke University HospitalCologneGermany
  4. 4.Department of Cardiothoracic SurgeryUniversity Hospital of RegensburgRegensburgGermany
  5. 5.Department of Anesthesiology and Critical Care MedicineUniversity Hospital of RegensburgRegensburgGermany
  6. 6.Department of Internal Medicine IIUniversity Hospital of RegensburgRegensburgGermany

Personalised recommendations