Trends in extracorporeal life support

December 20, 2016

For critically ill patients with heart or lung failure that does not respond to conventional treatments, extracorporeal life support (ECLS) can provide a bridge to survival. Updated analysis of a worldwide database finds that ECLS technologies are becoming more widely available and more frequently used at centers around the world, according to a report in the ASAIO Journal.

The new update from the Extracorporeal Life Support Organization (ELSO) registry—the first since 2012—summarizes current data on ECLS submitted to the registry. Writing on behalf of the ELSO registry, Dr. Ravi Thiagarajan and colleagues state, "The ELSO registry has collected important information on ECLS use from centers worldwide and has helped understand ECLS utilization and outcomes."

Latest Data on ECLS—Use, Outcomes, and Complications

Extracorporeal refers to the use of extracorporeal membrane oxygenation (ECMO) and other techniques to provide blood circulation and oxygenation for certain groups of . Like cardiopulmonary bypass during surgery, ECLS takes over the work of the heart and lung—but for a period of days or weeks, rather than just a few hours.

As of July, 2016, the ELSO registry included information on 78,397 infants, children, and adults receiving ELCS since 1989. In 2015, the last year of full data collection, ECLS was used in 7,901 patients at 310 centers worldwide. The report shows that ECLS is now being used more often in adults than in newborns with respiratory failure.

Overall, 70 percent of patients were successfully weaned off ECLS, while 58 percent survived to be discharged from the hospital. When ECLS was used for respiratory failure, the rate of survival to discharge in 74 percent for newborns (under 30 days) and 58 percent for older children and adults.

Newborns with respiratory failure remain the largest group of ECLS patients. However, the use of ECLS in this group of patients has decreased in recent years, while rates of survival to have decreased as well. These trends likely reflect advances in mechanical ventilation, resulting in a more critically ill group of infants being placed on ECLS.

Meanwhile, adults with respiratory failure are the fastest-growing group of ECLS patients. This trend may reflect the impact of the H1N1 influenza ("swine flu") epidemic, as well as a 2009 study (the CESAR trial) showing that ECMO improves survival in adults with severe .

ECLS is also used in patients with various causes of cardiac failure—overall rates of survival to hospital discharge were 42 percent for newborns, 51 percent for older children, and 41 percent for adults. As surgery to correct congenital heart defects becomes increasingly complex, the use of ECLS for cardiac support in infants and children is expected to grow.

There is also a trend toward increased use of ECLS in patients who don't respond to cardiopulmonary resuscitation. Rates of survival to hospital discharge in these "ECPR" cases remain relatively low: 41 percent for infants and children and 29 percent for adults.

Although ECLS is potentially lifesaving, the patients who need it are severely ill, and remain at high risk of complications and death. "Adverse events during the course of ECLS are common, and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams," Dr. Thiagarajan and coauthors write.

Given the complexity of ECLS technologies and the critical illness of requiring this type of support, continuous and analysis are essential to achieve continued progress in appropriate use and good clinical outcomes of ECLS. Dr. Thiagarajan and colleagues conclude, "The ELSO registry remains an important and valuable source of ECLS information that will continue to influence the use of ECLS."

Explore further: Extracorporeal life support is 'bridge-to-life' for patients with sudden onset cardiogenic shock

More information: Ravi R. Thiagarajan et al. Extracorporeal Life Support Organization Registry International Report 2016, ASAIO Journal (2016). DOI: 10.1097/MAT.0000000000000475

Related Stories

Extracorporeal life support is 'bridge-to-life' for patients with sudden onset cardiogenic shock

August 20, 2015
Cardiogenic shock is when a patient's heart is so severely damaged that it is no longer able to pump blood to the organs of the body. When this occurs, mechanical circulatory support may be the only hope for survival. While ...

Critically ill flu patients saved with artificial lung technology treatment

January 17, 2013
In recent weeks the intensive critical care units at University Health Network's Toronto General Hospital have used Extra Corporeal Lung Support (ECLS) to support five influenza (flu) patients in their recovery from severe ...

Experience saves lives: Advanced life-support study reveals differences in survival rates

March 25, 2015
An advanced form of life support that takes over for the failing hearts and lungs of critically ill patients saves lives. But for adults, the odds of surviving depend on which hospital provides the life-supporting treatment ...

Do nights, weekends affect survival after pediatric cardiac arrest in hospital?

November 7, 2016
For hospitalized children, the rate of surviving to discharge was lower for those who had cardiac arrest with cardiopulmonary resuscitation (CPR) at night compared with during the daytime and evening, according to an article ...

Recommended for you

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

Best of Last Year – The top Medical Xpress articles of 2016

December 23, 2016
(Medical Xpress)—It was a big year for research involving overall health issues, starting with a team led by researchers at the UNC School of Medicine and the National Institutes of Health who unearthed more evidence that ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.