title: A Suprainstitutional Network for Remote Extracorporeal Life Support: A Retrospective Cohort Study.
abstract: This study sought to evaluate patient outcome within the Düsseldorf Extracorporeal Life Support (ECLS) Network, a suprainstitutional network for rapid-response remote ECLS and to define survival-based predictors.
  
  
  
  Mobile venoarterial extracorporeal membrane oxygenation (vaECMO) used for ECLS has become a treatment option for a patient population with an otherwise fatal prognosis. However, outcome data remain scarce and institutional standards required to manage these patients are still poorly defined.
  
  
  
  This retrospective cohort study analyzes the outcome of 115 patients consecutively treated between July 2011 and October 2014 within the Düsseldorf ECLS Network due to refractory circulatory failure.
  
  
  
  Of the 115 patients (56 ± 15 years of age, vaECMO initiation under cardiopulmonary resuscitation [CPR] 77%, CPR duration 45 [range 5 to 90] min), 50 patients (44%) survived to primary discharge and 38 patients (33%) were alive after a median follow-up of 1.5 years (95% confidence interval [CI]: 1.2 to 1.7). Thirty-seven (97%) of the long-term survivors showed a favorable neurological outcome. Risk factors associated with mortality during vaECMO were CPR duration (hazard ratio [HR]: 1.006; 95% CI: 1.00 to 1.01) and ischemic stroke (HR: 2.63; 95% CI: 1.52 to 4.56). Risk factors associated with mortality after vaECMO weaning were renal failure (HR: 6.60; 95% CI: 2.72 to 16.01) and sepsis (HR: 3.6; 95% CI: 1.50 to 8.69). Visceral ischemia had a negative impact (HR: 0.30; 95% CI: 0.11 to 0.84) whereas assist device implantation promoted successful vaECMO weaning (HR: 2.95; 95% CI: 1.65 to 5.25). Further, 3 distinct risk groups with significant differences in survival could be identified, demonstrating that in patients with no or short CPR mortality was not conditioned by age, whereas in patients with prolonged CPR young age was associated with increased survival.
  
  
  
  This study illustrates the implementation of a suprainstitutional ECLS Network. Further, our data suggest that mobile vaECMO is beneficial for a larger patient population than actually expected, especially regarding young patients presenting with prolonged CPR or patients regardless of age with no or short CPR.
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Hug
authors.initials: H
authors.lastname: Aubin
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: George
authors.initials: G
authors.lastname: Petrov
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Hannan
authors.initials: H
authors.lastname: Dalyanoglu
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Diyar
authors.initials: D
authors.lastname: Saeed
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Payam
authors.initials: P
authors.lastname: Akhyari
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Paprotny
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Maximillian
authors.initials: M
authors.lastname: Richter
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Department of Vascular and Endovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Schelzig
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Anesthesiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Kindgen-Milles
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. Electronic address: artur.lichtenberg@med.uni-duesseldorf.de.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D003663:Decision Trees; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005858:Germany; D006323:Heart Arrest / Q000628:therapy*; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors
keywords: acute circulatory failure; cardiogenic shock; extracorporeal cardiopulmonary resuscitation; extracorporeal life support; extracorporeal membrane oxygenation