elso registry 2012. original ecmo registry report 1988

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ELSO Registry 2012

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Page 1: ELSO Registry 2012. Original ECMO Registry Report 1988

ELSO Registry

2012

Page 2: ELSO Registry 2012. Original ECMO Registry Report 1988

Original ECMO Registry Report 1988

Page 3: ELSO Registry 2012. Original ECMO Registry Report 1988

Original Registry Report 1988Neonatal ECMO Outcomes

Page 4: ELSO Registry 2012. Original ECMO Registry Report 1988

Original Registry Report 1988

Page 5: ELSO Registry 2012. Original ECMO Registry Report 1988

Original Registry ReportCalibrating the Learning CurveImprovement up to 30 cases

Page 6: ELSO Registry 2012. Original ECMO Registry Report 1988
Page 7: ELSO Registry 2012. Original ECMO Registry Report 1988

7

ELSO Centers, 2012

T

Page 8: ELSO Registry 2012. Original ECMO Registry Report 1988

8

Euro-ELSO Meeting

Page 9: ELSO Registry 2012. Original ECMO Registry Report 1988

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%

Page 10: ELSO Registry 2012. Original ECMO Registry Report 1988

10 ELSO Registry July 2012

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

Page 11: ELSO Registry 2012. Original ECMO Registry Report 1988

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

Page 12: ELSO Registry 2012. Original ECMO Registry Report 1988

12 ELSO Registry July 2012

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

Page 13: ELSO Registry 2012. Original ECMO Registry Report 1988

13 ELSO Registry July 2012

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

Page 14: ELSO Registry 2012. Original ECMO Registry Report 1988

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

Page 15: ELSO Registry 2012. Original ECMO Registry Report 1988

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

Page 16: ELSO Registry 2012. Original ECMO Registry Report 1988

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

Page 17: ELSO Registry 2012. Original ECMO Registry Report 1988

17 ELSO Registry July 2012

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

Page 18: ELSO Registry 2012. Original ECMO Registry Report 1988

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?

Page 19: ELSO Registry 2012. Original ECMO Registry Report 1988

19

Page 20: ELSO Registry 2012. Original ECMO Registry Report 1988

20

Page 21: ELSO Registry 2012. Original ECMO Registry Report 1988

21

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

Page 22: ELSO Registry 2012. Original ECMO Registry Report 1988

22

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

Page 23: ELSO Registry 2012. Original ECMO Registry Report 1988

23

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

Page 24: ELSO Registry 2012. Original ECMO Registry Report 1988

24

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

Page 25: ELSO Registry 2012. Original ECMO Registry Report 1988

25

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

Page 26: ELSO Registry 2012. Original ECMO Registry Report 1988

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]

Page 27: ELSO Registry 2012. Original ECMO Registry Report 1988
Page 28: ELSO Registry 2012. Original ECMO Registry Report 1988

F:\ECMO\Slide_16.jpgF:\ECMO\Slide_16.jpg

Esperanza. The first neonatal ECMO survivor, Bartlett and Gazzaniga 1975

Page 29: ELSO Registry 2012. Original ECMO Registry Report 1988