elso registry 2012. original ecmo registry report 1988
TRANSCRIPT
ELSO Registry
2012
Original ECMO Registry Report 1988
Original Registry Report 1988Neonatal ECMO Outcomes
Original Registry Report 1988
Original Registry ReportCalibrating the Learning CurveImprovement up to 30 cases
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ELSO Centers, 2012
T
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Euro-ELSO Meeting
9 ELSO Registry July 2012
Overall Patient Outcomes
Total Surv ECLS Surv to DC Neonatal Respiratory 25,746 21,765 85% 19,232 75% Cardiac 4,797 2,928 61% 1,912 40% ECPR 784 496 63% 304 39% Pediatric Respiratory 5,457 3,556 65% 3,061 56% Cardiac 5,976 3,855 65% 2,913 49% ECPR 1,562 843 54% 630 40% Adult Respiratory 3,280 2,094 64% 1,808 55% Cardiac 2,312 1,243 54% 891 39% ECPR 753 276 37% 207 27% Total 50,667 37,056 73% 30,958 61%
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Runs by Year
19901992
19941996
19982000
20022004
20062008
20102012
0%
20%
40%
60%
80%
100%
Series8
Card (16 years and over)
Card (1 year < 16 years)
Card (31 days < 1 year)
Card (0 - 30 days)
Adult Pulm
Ped Pulm
Neo Pulm
11 ELSO Registry July 2012
Neonatal Respiratory Cases
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
200
400
600
800
1000
1200
1400
1600
0
5000
10000
15000
20000
25000
30000
Ann
ual R
uns
Cum
ulat
ive
Run
s
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Neonatal Survival by Diagnosis and Year
<=87
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0%
25%
50%
75%
100%
CDH MAS PPHN RDS Sepsis Others
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Pediatric Survival by Diagnosis and Year
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0%10%20%30%40%50%60%70%80%90%
100%
Viral Pneum Bact Pneum Aspir ARDS ARF Others
14 ELSO Registry July 2012
Adult Survival by Diagnosis and Year
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0%
25%
50%
75%
100%
Viral Pneum Bact Pneum Aspir ARDS ARF Others
15 ELSO Registry July 2012
VA17%
VA+V1%
VV46%Other
1%
Not Recorded12%
VV-VA4%
VVDL18%
VA-VV1% VA
VA+V
VV
Other
Not Recorded
VV-VA
VVDL
VA-VV
Initial Mode of Adult Respiratory Support
16 ELSO Registry July 2012
Cardiac Survival by Diagnosis and Year Under 16 years
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0%
25%
50%
75%
100%
Congenital Defect Cardiac Arrest Cardiogenic Shock Cardiomyopathy MyocarditisOthers
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Cardiac Survival by Diagnosis and Year 16 years old and over
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0%
25%
50%
75%
100%
Congenital Defect Cardiac Arrest Cardiogenic Shock Cardiomyopathy MyocarditisOthers
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?
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Benchmarking/Quality AssuranceCenter Specific Complications
International Summary 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%
Renal: Hemofiltration required 85 23.5% 33 39%
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%
Total Registry Complications
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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
ELSO Registry January 2011
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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
ELSO Registry January 2011
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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
ELSO Registry January 2011
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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
ECMOII vs ECMO I
Registry committee, underway
Peter Rycus
Executive Administrator of ELSOManging Editor of ELSO PublicationsManager of the ELSO RegistryELSO Meeting coordinatorELSO Course coordinator
Voice of ELSO +1-734-998-6600 [email protected]
F:\ECMO\Slide_16.jpgF:\ECMO\Slide_16.jpg
Esperanza. The first neonatal ECMO survivor, Bartlett and Gazzaniga 1975