OBJECTIVES: The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. METHODS: This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. RESULTS: After a mean venoarterial extracorporeal membrane oxygenation therapy of 6.9 ± 6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after venoarterial extracorporeal membrane oxygenation therapy for more than 7 days was 60.5% (P = .105). Centers that had treated more than 50 patients with postcardiotomy venoarterial extracorporeal membrane oxygenation had a significantly lower hospital mortality than lower-volume centers (60.7% vs 70.7%, adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.82). The postcardiotomy extracorporeal membrane oxygenation score was derived by assigning a weighted integer to each independent pre-venoarterial extracorporeal membrane oxygenation predictors of hospital mortality as follows: female gender (1 point), advanced age (60-69 years, 2 points; ≥70 years, 4 points), prior cardiac surgery (1 point), arterial lactate 6.0 mmol/L or greater before venoarterial extracorporeal membrane oxygenation (2 points), aortic arch surgery (4 points), and preoperative stroke/unconsciousness (5 points). The hospital mortality rates according to the postcardiotomy extracorporeal membrane oxygenation score was 0 point, 45.6%; 1 point, 40.5%; 2 points, 51.1%; 3 points, 57.8%; 4 points, 70.7%; 5 points, 68.3%; 6 points, 77.5%; and 7 points or more, 89.7% (P < .0001). CONCLUSIONS: Age, female gender, prior cardiac surgery, preoperative acute neurologic events, aortic arch surgery, and increased arterial lactate were associated with increased risk of early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Center experience with postcardiotomy venoarterial extracorporeal membrane oxygenation may contribute to improved results.

Cardiothoracic Department University Hospital of Udine Udine Italy

Cardiovascular Surgery University Hospital of Duesseldorf Dusseldorf Germany

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 Ziekenhuis Oost Limburg Genk Belgium

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

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

Comment In

J Thorac Cardiovasc Surg. 2020 May;159(5):1855-1856. doi: 10.1016/j.jtcvs.2019.07.036. PubMed

References provided by Crossref.org

Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations: Insights from the PELS observational study

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study

Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study

Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation