Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is a lifesaving tool in cardiovascular care, providing excellent hemodynamic assistance for numerous indications, such as cardiogenic shock or periprocedural support in patients with acute heart failure.¹ In addition, VA-ECMO evolved as a salvage therapeutic tool in cardiopulmonary resuscitation (CPR) situations refractory to medical treatment, with so-called extracorporeal CPR potentially improving outcome.² Despite the increasing use of VA-ECMO support, the mortality of these patients is still high, and there are only a few randomized data demonstrating no clear benefit of this therapeutic option.³

We aimed to analyze the incidence and outcome of all VA-ECMO procedures performed in Germany from 2007 to 2015 by using administrative data from the German Federal Health Monitoring System to investigate whether changes in incidence might influence in-hospital mortality.