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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an established treatment option in critically ill patients with acute respiratory distress syndrome (ARDS). The overall mortality in patients with ARDS has fallen over the past 30 years. VV-ECMO for selected patients has contributed to this. In Denmark, VV-ECMO is centralised to Aarhus University Hospital and Rigshospitalet, as it is a complex multidisciplinary therapy. The treatment involves many specialities and personnel groups, all with special training and experience. This review presents the current literature in the ARDS and ECMO treatment.

Randomized controlled trials (RCTs) have been considered the reference standard for evaluation of drug effects. Controversy exists concerning observational studies because of the lack of blinding and the risk of uncontrolled confounding. However, RCTs also have limitations, including short follow-up and relatively small study populations, which make it impossible to examine rare events and cross-over problems. None of the designs provides perfect information and both designs are needed in the evaluation of drug effects.

Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish registries to compute HSMRs.By linking hospital discharge registries with the Danish Civil Registration System, we identified 77 primary discharge diagnoses that accounted for 80% of all deaths within 30 days of admission. We calculated overall death rates stratified by the 77 primary discharge diagnoses, age, gender, and type of admission and used these to compute the expected number of deaths. HSMR for each hospital was calculated as the ratio of observed to expected number of deaths.Pneumonia, non-specified was the diagnosis that accounted for most deaths within 30 days after admission. The crude mortality rate varied from 5.7% to 6.3%. HSMR varied little--from 95 and 98 in Hospitals B and D to 102 and 103 in Hospitals A and C, respectively.We found that it was possible to use data from Danish administrative registries to compute HSMR and that HSMR varied little between hospitals with comparable case-mixes.

Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. Data from several studies suggest that suboptimal standards of intensive care are relatively common. Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.