ELSO Registry
2012
Original ECMO Registry Report 1988
Original Registry Report 1988
Neonatal ECMO Outcomes
Original Registry Report 1988
Original Registry Report
Calibrating the Learning Curve
Improvement up to 30 cases
ELSO Centers, 2012
T
7
Euro-ELSO Meeting
8
Overall Patient Outcomes
Total
Neonatal
Respiratory
Cardiac
ECPR
Pediatric
Respiratory
Cardiac
ECPR
Adult
Respiratory
Cardiac
ECPR
Total
9
Surv ECLS
Surv to DC
25,746 21,765 85%
4,797 2,928 61%
784
496 63%
19,232 75%
1,912 40%
304 39%
5,457
5,976
1,562
3,556 65%
3,855 65%
843 54%
3,061 56%
2,913 49%
630 40%
3,280
2,312
753
2,094 64%
1,243 54%
276 37%
1,808 55%
891 39%
207 27%
50,667 37,056 73%
30,958 61%
ELSO Registry July 2012
Runs by Year
100%
Card (16 years and over)
80%
Card (1 year < 16 years)
Card (31 days < 1 year)
Card (0 - 30 days)
60%
Adult Pulm
Ped Pulm
Neo Pulm
40%
20%
0%
10
ELSO Registry July 2012
Neonatal Respiratory Cases
1600
30000
1400
Annual Runs
1200
20000
1000
800
15000
600
10000
400
5000
200
0
11
0
ELSO Registry July 2012
Cumulative Runs
25000
Neonatal Survival by Diagnosis and Year
100%
75%
50%
25%
0%
<=87 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011
CDH
12
MAS
PPHN
RDS
ELSO Registry July 2012
Sepsis
Others
Pediatric Survival by Diagnosis and Year
100%
75%
50%
25%
0%
Viral Pneum
13
Bact Pneum
Aspir
ARDS
ELSO Registry July 2012
ARF
Others
Adult Survival by Diagnosis and Year
100%
75%
50%
25%
0%
Viral Pneum
14
Bact Pneum
Aspir
ELSO Registry July 2012
ARDS
ARF
Others
Initial Mode of Adult Respiratory Support
VA-VV, 1%
VA, 17%
VA
VA+V, 1%
VVDL, 18%
VA+V
VV
Other
VV-VA, 4%
Not Recorded
VV-VA
Not Recorded,
12%
VV, 46%
Other, 1%
15
VVDL
VA-VV
ELSO Registry July 2012
Cardiac Survival by Diagnosis and Year
Under 16 years
100%
75%
50%
25%
Congenital Defect
Cardiomyopathy
16
Cardiac Arrest
Myocarditis
ELSO Registry July 2012
Cardiogenic Shock
Others
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0%
Cardiac Survival by Diagnosis and Year
16 years old and over
100%
75%
50%
25%
Congenital Defect
Cardiomyopathy
17
Cardiac Arrest
Myocarditis
ELSO Registry July 2012
Cardiogenic Shock
Others
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0%
ELSO Registry Applications
•
•
•
•
•
•
•
Case questions
Overall and specific reports
Document trends and progress
Identify ECMO centers
Epidemic management (H1N1)
Center specific, benchmark data
Center certification?
19
20
Benchmarking/Quality Assurance
Center Specific Complications
Neurologic: Seizures: clinically determined
6
1.7%
2
33%
Neurologic: CNS infarction by US/CT
5
1.4%
1
20%
Neurologic: CNS hemorrhage by US/CT
11
3.0%
1
9%
Renal: Creatinine 1.5-3.0
140
38.7%
62
44%
Renal: Creatinine > 3.0
78
21.5%
28
36%
Renal: Dialysis required
63
17.4%
22
35%
33
39%
Renal: Hemofiltration
required
International
85
23.5%
Summary Complications
Total Registry Complications
21
Neurologic: Seizures: EEG determined
12
0.5%
6
50%
Neurologic: CNS infarction by US/CT
45
1.9%
9
20%
Neurologic: CNS hemorrhage by US/CT
91
3.8%
16
18%
Renal: Creatinine 1.5-3.0
468
19.5%
169
36%
Renal: Creatinine > 3.0
316
13.3%
123
39%
Renal: Dialysis required
393
16.3%
152
39%
Renal: Hemofiltration required
545
22.7%
270
50%
Registry Reports
 > 200 papers and >20 chapters refer to ELSO Registry
 > 40 Papers based on Registry Reviews
Registry Review : Examples
Adult Respiratory Failure:50 % overall survival
Brogan, ICM, 2009
Prematurity:IVH 6%, survival 53%<2 kg
Romiarek, J Peds Srg, 2004
Post Lung XP: 151 cases 42% survival
Fischer, JHLT, 2007
22
ELSO Registry January 2011
Registry Reports
Registry Reviews
Mechanical Complications:15% cases, related to duration
Fleming, PCCM, 2009
Infection: 12% incidence, related to duration
Bizzaro, Ped CCM, 2011
Registry Review re Question:
Vent days pre ECMO in peds, no effect until 14 d
Domico,PedCCM, 2012
VV=VA in CDH
Dimmit, JPeds Surg, 2001
23
ELSO Registry January 2011
Registry as a Control Database
Berlin Heart FDA qualifying trial: 2009-2011
ECMO Bridge to Pediatric Heart Transplant:
ELSO database, 773 Cases, 45% transplanted,
46% survival
Almand, Circulaton, 2011
Berlin Heart Study Design,
Case matching to ELSO Data, 48 cases
EMO survival 60%, BH survival 92%
Almand, Am Heart J, 2011
Berlin Heart FDA approved, 2011
24
ELSO Registry January 2011
Registry Prospective Studies
H1N1 Flu epidemic
Brief case entry, essential data
Brief Case outcome
Continuous update during epidemic:
Incidence, Age, vent days, obesity, pregnancy,
ECLS days , outcome, Guidelines
Neonatal follow up at age 18+
Engle, underway
25
ECMOII vs ECMO I
Registry committee, underway
Peter Rycus
Executive Administrator of ELSO
Manging Editor of ELSO Publications
Manager of the ELSO Registry
ELSO Meeting coordinator
ELSO Course coordinator
Voice of ELSO +1-734-998-6600
elso@med.umich.edu
F:\ECMO\Slide_16.jpgF:\ECMO\Slide_16.jp
g
Esperanza. The first neonatal ECMO survivor,
Bartlett and Gazzaniga 1975