The Extracorporeal Life Support Organization (ELSO) is a non profit organization established in 1989 supporting health care professionals and scientists who are involved in extracorporeal membrane oxygenation (ECMO). ELSO maintains a registry of both facilities and specialists trained to provide ECMO services. ELSO also maintains registry information that is used to support clinical research, support regulatory agencies, and support individual ELSO centers. ELSO provides educational programs for active centers as well as for facilities who may be involved in the transfer of patients to higher levels of care.
The Extracorporeal Life Support Organization (ELSO) Registry is used by a variety of stakeholders to improve patient and institutional care quality, support research and device regulation, monitor practice patterns, and share best practices. To achieve these goals, Registry data must be accurate and reliable. In this article, we review the process of ELSO Registry data collection, assess data completeness and integrity, and report on the current status of the data. While accuracy is generally high, it can vary, leaving room for further improvement. Understanding the quality of the data is essential for using it effectively.
Abstract Purpose Veno-arterial extracorporeal oxygenation (VA-ECMO) provides comprehensive cardiopulmonary support in patients with cardiogenic shock (CS), but may result in complications. While complications rates are known, their impact on risk of death remains largely unknown. Methods Using the Extracorporeal Life Support Organization (ELSO) Registry to identify adults with a diagnosis of CS treated with VA-ECMO (2017–2024), we analyzed the association between timing and type of complication and in-hospital mortality using three methodologies: 1) Cox proportional hazards analysis, treating complications as time-dependent covariates; 2) Multi-State Model (MSM) analysis, treating complications as transient states and estimating the differential mortality rate from each of these states; and 3) landmark Kaplan Meier survival analysis, estimating conditional survival curves, given survival to 3 weeks, based on count and timing of complications. Results Among 22,547 patients (31.7% female), 12,094 (54%) died during index hospitalization. More non-survivors experienced complications than survivors (74% vs 54%), with all sub-types occurring more frequently. Neurologic complications increased the hazard of mortality by 3.6 (95% C.I 3.4 - 3.8). MSM analysis indicated that the absolute 30-day risk of mortality was greater if a patient had a complication, increasing from 48.6% (0 complications) to 93.1% with a neurologic complication. Landmark survival analysis demonstrated that patients without complications within the first 3 weeks had the highest conditional survival. Conclusion Complications on VA-ECMO have a significant and cumulative effect on in-hospital mortality, with a higher number associated with increased risk of death. Neurologic and pulmonary complications were associated with the greatest mortality risk.
Abstract Background Veno-arterial extracorporeal oxygenation (VA ECMO) provides comprehensive circulatory support in patients with cardiogenic shock (CS) but is associated with a high incidence of complications. The relative impact of specific complications on the risk of death remains largely unknown. Methods The Extracorporeal Life Support Organization (ELSO) Registry was used to identify adult patients with CS who received VA ECMO between 2017 and 2024. For each patient, complications sustained during VA ECMO were recorded within the registry and categorized by organ system. The association between the number and type of complication and in-hospital mortality was analyzed using a Cox proportional hazards analysis. Results A total of 23,103 patients (31.7% female) were included in the study, of whom 12,442 (54%) died during index hospitalization. Complications occurred more frequently in non-survivors than survivors (74% vs 54%, p < 0.001). Neurologic complications were associated with the greatest increase in mortality (adjusted HR 3.6 [95% C.I 3.4 - 3.8] for one neurologic complication), followed by pulmonary complications (adjusted HR 2.0 [95% CI 1.8-2.2]). Across all complication categories, patients with increasing number of complications had the worst survival. Conclusion Complications on VA ECMO support have a significant and cumulative effect on in hospital mortality, with a higher number of complications portending increased risk of death. Neurologic complications are associated with the highest risk of mortality. These data may help improve risk stratification of patients receiving VA ECMO and inform discussions with patients and their families.
OBJECTIVE:To describe those neonates with dextro-transposition of the great arteries (d-TGA) who undergo preoperative support with extracorporeal membrane oxygenation (ECMO) and to compare outcomes in those undergoing the arterial switch operation (ASO) on-ECMO vs. those who undergo ASO after weaning from ECMO. DESIGN:Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry data, 2000-2022. PATIENTS:Neonates aged up to 21 days with d-TGA supported by ECMO before ASO. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We identified 100 neonates with a median (interquartile range [IQR]) age at ECMO initiation of 4 days (IQR 1-9) and median weight of 3.4 kg (IQR 3-3.7). Mortality, as opposed to survival, was associated with the following: older age at ECMO initiation (7 d [IQR 2-12] vs. 2 d [IQR 1-6], p = 0.01), lower birthweight (3.2 kg [IQR 2.8-3.7] vs. 3.5 kg [IQR 3.1-3.7], p = 0.04), longer aortic clamp time (129 min [IQR 94-191] vs. 98 min [IQR 72-121], p = 0.02), longer cardiopulmonary bypass time (326 min [IQR 217-415] vs. 174 min [IQR 137-241], p < 0.001), and longer duration of ECMO support (7 d [IQR 4-11] vs. 4 d [IQR 2-5], p < 0.001). Also, mortality, compared with survival, was associated with occurrence of any complication and the need for renal replacement therapy (both p < 0.001). Overall, 64 of 91 (70%) neonates supported with preoperative ECMO underwent ASO on ECMO. In comparison with those undergoing ASO after ECMO, these patients had more complications (53/64 [83%] vs. 16/27, p = 0.02) and had higher mortality than those weaned from ECMO preoperatively (24/64 [38%] vs. 4/27, p = 0.03). CONCLUSIONS:In the ELSO 2000-2022 cohort of neonates with d-TGA, supported with preoperative ECMO, overall mortality was 33%. Continued postoperative ECMO support was associated with worse mortality. Therefore, we wonder whether successful weaning from ECMO before ASO may be associated with improved outcomes.
The Extracorporeal Life Support Organization (ELSO) has progressively transformed its guideline framework to meet the increasing clinical, scientific, and operational demands of modern extracorporeal life support. Since its establishment in 1989, ELSO has supported Extracorporeal Membrane Oxygenation (ECMO) programs worldwide through education, data reporting, and consensus-building. Recent expansions in ECMO utilization, coupled with rapidly growing evidence, have necessitated a more structured, transparent, and internationally representative approach to guideline development.In 2023, ELSO expanded the Guideline Subcommittee (GSC) to ensure participation from all ELSO chapters and key professional disciplines. This expansion enables the implementation of a standardized workflow encompassing proposal submission, methodological review, authorship requirements, external peer review, plagiarism screening, and final Board approval. The updated process emphasizes consistency, timely production, and methodological rigor across all ELSO guidelines.This manuscript summarizes the current ELSO guideline development process and highlights four recently published guidelines addressing early mobility, adult neuromonitoring, ECMO in pregnancy and the peripartum period, and accidental hypothermia. Each guideline reflects the available evidence integrated with multidisciplinary expert input, with the goal of providing globally applicable, practical recommendations for ECMO clinicians. The review also outlines the formal guideline update cycle and ELSO's expanding collaborations with international societies to produce joint guidance documents.As ECMO practice continues to evolve, ELSO remains committed to advancing high-quality, accessible guidelines that support consistent standards of care across diverse healthcare systems. Future priorities include guidelines on ECMO during cardiopulmonary resuscitation, trauma, and other high-impact clinical areas, along with enhanced education and training pathways to strengthen ECMO practice globally.
