Association Between Hospital-Level Volume of Extracorporeal Membrane Oxygenation and Complications: A Clustered, Mixed-Effect Analysis of the Extracorporeal Life Support Organization Registry
Authors' conclusion
Higher annual center-volumes of ECMO were associated with decreased pulmonary complications for VV, decreased hemorrhagic complications for VA and VV cohorts and an increase in mechanical complications for VA cohort but not ECPR alone.
Study context
- Population
- Adults (≥18 yr) on Extracorporeal Membrane Oxygenation (ECMO), Extracorporeal Life Support Organization Registry, 2018–2021
- Participants
- 9,427 / 10,794 / 3,595
- Exposure
- Annual ECMO center-volume and complication rates
- VVn = 9,427
- Venoarterial (VA)n = 10,794
- Extracorporeal cardiopulmonary resuscitation (ECPR)n = 3,595
- Outcome
- Rate of ECMO-related complications by center-volume
Methodological detailsclustered mixed-effects logistic regression, multicentre registry, 281 VV, 275 VA, 224 ECPR centers
- Clustered mixed-effects logistic regression
- Multicentre registry
- 281 VV, 275 VA, 224 ECPR centers
Main finding
As reported in the abstract
ECMO-related complications per increase in annual center-volume
VV
74
Average annual center-volume · ± 55
VA
80
Average annual center-volume · ± 55
ECPR
89
Average annual center-volume · ± 58
Adjusted odds ratio (CI)
VAmechanical complications
1.004(1.001–1.008)
VVhemorrhagic complications
0.997(0.994–0.999)
VAhemorrhagic complications
0.997(0.994–0.999)
VVpulmonary complications
0.997(0.994–1.000)
Per increase in annual center-volume, as printed
Observational data: associations, not effects.
Original publication
Association Between Hospital-Level Volume of Extracorporeal Membrane Oxygenation and Complications: A Clustered, Mixed-Effect Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Med. Published 17 February 2026. doi:10.
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