BACKGROUND: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery. METHODS: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed. RESULTS: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P = .029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I2, 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I2, 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older. CONCLUSIONS: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients.

Cardiothoracic Department University Hospital of Udine Udine Italy

Department of Cardiac Surgery Glenfield Hospital University Hospitals of Leicester Leicester United Kingdom

Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden

Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow United Kingdom

Department of Cardiothoracic Surgery Henri Mondor University Hospital AP HP Paris Est University Créteil France

Department of Cardiothoracic Surgery Münster University Hospital Münster Germany

Department of Cardiothoracic Surgery University of Lund Lund Sweden

Department of Cardiothoracic Transplantation and Vascular Surgery S Orsola Hospital University of Bologna Bologna Italy

Department of Cardiovascular Surgery University Hospital of Dusseldorf Dusseldorf Germany

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Molecular Medicine and Surgery and Department of Cardiac Surgery Karolinska Institute Karolinska University Hospital Stockholm Sweden

Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz Besançon France

Department of Vascular Surgery Nancy University Hospital University of Lorraine Nancy France

Division of Cardiac Surgery Ospedali Riuniti Trieste Italy

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital Reims France

Hamburg University Heart Center Hamburg Germany

Heart Center Turku University Hospital and Department of Surgery University of Turku Turku Finland

Heart Center Turku University Hospital and Department of Surgery University of Turku Turku Finland; Department of Surgery University of Oulu Oulu Finland

Institute of Clinical and Experimental Medicine Prague Czech Republic

Prince Sultan Cardiac Center Al Hassa Saudi Arabia

References provided by Crossref.org

Postcardiotomy extracorporeal membrane oxygenation in patients older than 70 years: Characteristics, outcomes, and variables associated with mortality

Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry