Work

Center Experience, Learning Curves, Run Durations, and Outcomes in Venovenous Extracorporeal Membrane Oxygenation

Year: 2026

Type: article

Abstract: Purpose Expanding availability of venovenous ECMO (VV ECMO) and increasing frequency of prolonged ECMO runs challenge standard definitions of center experience based solely on case counts. We examined the relationship between center experience and patient outcome using annual VV ECMO-day-volume (total days of VV ECMO support per center-year), a metric that integrates both procedural frequency and exposure to prolonged support and may better reflect institutional expertise. Methods We examined adult patients in the Extracorporeal Life Support Organization (ELSO) Registry supported with VV ECMO between 2014 and 2024. The association between center experience, in-hospital mortality, and ECMO-related complications were examined using mixed-effect models adjusted for illness severity, calendar year, and clustering within centers. Results Among 54,036 patients, center experience was independently associated with lower in-hospital mortality and fewer ECMO-related complications. Each doubling of annual VV ECMO-days was associated with a 4% reduction in the odds of death (OR 0.96; 95% CI, 0.93–0.98). The association was most pronounced among centers with longer average ECMO run duration (> 18 days; OR 0.95; 95% CI, 0.91–0.99), whereas no significant volume-mortality association was observed in centers with shorter average run duration. Center learning was observed to increase quickly and plateau as experience is gained, allowing for newly established centers to rapidly achieve expertise. Conclusion Higher VV ECMO-day-volume is associated with lower in-hospital mortality and fewer ECMO-related complications. This metric incorporates frequency and duration of support and provides a more comprehensive measure of center experience than case counts alone.

Source: CHEST Critical Care

DOI: 10.1016/j.chstcc.2026.100301