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Status: 14.12.2021 6:00 a.m.
The mortality from treatments with the ECMO is significantly higher in Germany than in most other countries. To ContrastsToo many clinics with too little experience carry out the therapy.
The ECMO (extracorporeal membrane oxygenation) is an artificial lung, small, flexible, high-tech. For corona patients, it is the last hope when the virus has caused the lungs to fail. But mortality in Germany is strikingly high: on average, 68 percent of patients die during treatment. This is shown by the evaluation of a research group led by the intensive care physician Christian Karagiannidis from Cologne.
In ECMO therapy, a machine draws blood from the patient’s body, enriches it with oxygen, and then pumps it back into the body. This is supposed to give the damaged lungs a breather; she should recover. Sounds simple, but it’s highly complex. It depends very much on the experience of doctors and on the care key.
Worldwide lower death rates than in Germany
Such a high mortality in a country like Germany would probably be avoidable, as research by the ARD politics magazine Contrasts show. The intensive care doctor Karagiannidis also considers them unacceptable. Because other countries have better survival rates: According to an evaluation of the ECMO therapies in the greater Paris area, almost every second patient still lived there 90 days after the ECMO therapy. It comes to a similar conclusion the worldwide ECMO register: the mortality rate was put there at 51.9%.
3376 corona patients were treated with an ECMO in Germany from March 2020 to the end of May 2021. This is shown by billing data from the hospitals. It is known whether these patients benefited from the therapy or whether they have died. The group around the intensive care doctor Karagiannidis evaluated all of these cases and calculated a mortality rate of 68 percent.
The fact that older patients are connected to the ECMO machines in Germany may contribute to the high death rate in Germany: the average age in Germany was 57 years – internationally it is closer to 51. The chances of survival decrease with age.
Many hospitals with little expertise
But the decisive factor is that many patients in this country are treated in clinics with little expertise. The number of hospitals offering ECMO treatment has increased from 231 to 274 over the course of the pandemic. This was found out by the intensive care physician Benjamin Friedrichson from the Frankfurt University Hospital, who has been researching the topic of ECMO for years.
If you take a closer look at the numbers, you can see that most of these clinics have little expertise: According to the intensive care physician Friedrichson, 205 of these 274 hospitals have fewer than ten ECMO treatments per year – an average of just four.
Survival rates increase with more than 30 treatments a year
However, experience in handling the devices and the associated expertise play a decisive role in the survival of the patient. This was recently shown by the study in the greater Paris area: According to this, survival rates increase significantly if clinics carry out at least 30 ECMO treatments per year.
This knowledge is not reflected in the German hospital system. In Germany, every hospital that trusts the use of the devices is allowed to use and bill an ECMO. There are no minimum quantities or binding quality standards. We know from numerous studies that the selection of patients and the question of when the device is best connected requires a lot of expertise.
92,000 euros for an ECMO therapy
The therapy is well reimbursed in the German case flat rate system: the AOK paid an average of 92,000 euros per case, compared to 34,200 euros for invasive ventilation. Even so, intensive care doctor Karagiannidis doesn’t believe that a hospital can really make money with ECMO therapies. The consumables, cannulas and tubes, for example, are very expensive and the personnel expenditure is immense.
The economic incentive probably plays a role in other respects: In competition with other hospitals, it is good if a hospital can decorate itself with an ECMO. And once the device has been purchased, it has to be used.
Special ECMO centers increase the chance of survival
This wild growth can have fatal consequences for seriously ill patients. “It is possible that patients die in hospitals with little experience who would have survived if they had been brought to a large center in good time,” says senior physician Dirk Lunz from the Regensburg University Hospital. The Uniklinik Regensburg operates a large, globally recognized ECMO center.
on Contrasts-The clinic reported: The death rate was “only” 46.4 percent in the period from March 2020 to May 2021. “So we were more than 20 percent better, although we treat the sickest of the sick patients,” confirms senior physician Lunz. The special focus of the Regensburg company is on the transport of seriously ill ECMO patients: trained teams fly by helicopter, mainly to hospitals in Eastern Bavaria, put on the ECMO professionally and bring the patients to the center in Regensburg.
Senior physician Lunz believes that six to eight such ECMO centers would be completely sufficient for Bavaria. Projected for Germany that would mean: This complex and invasive treatment could be concentrated in around 50-60 locations.
Munich has as many ECMO clinics as all of England
In the city of Munich alone, however, ECMO therapies are now offered in eight different hospitals. As much as in the whole of England, by the way: There, this therapy has even been concentrated in just eight locations that supply the entire country by helicopter.
The intensive care doctor Karagiannidis also says that state regulation is overdue. He calls for such highly complex treatments as ECMO therapy to be concentrated in selected centers, in so-called level 3 hospitals. He is also thinking of around 60 centers for all of Germany. “That would save lives,” said Karagiannidis.