AIMS: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiogenic shock (PCS) after adult cardiac surgery is associated with satisfactory hospital survival. However, data on long-term survival of these critically ill patients are scarce. METHODS AND RESULTS: Between January 2010 and March 2018, 665 consecutive patients received VA-ECMO for PCS at 17 cardiac surgery centres and herein we evaluated their 5-year survival. The mean follow-up of this cohort was 1.7 ± 2.7 years (for hospital survivors, 4.6 ± 2.5 years). In this cohort, 240 (36.1%) patients survived to hospital discharge. Five-year survival of all patients was 27.7%. The PC-ECMO score was predictive of 5-year survival in these patients (0 point, 50.9%; 1 point, 44.9%; 2 points, 40.0%; 3 points, 34.7%; 4 points, 21.0%; 5 points, 17.6%; ≥6 points, 10.7%; P < 0.0001). Age was among factors independently associated with late survival, patients >70 years old having a remarkably poor 5-year survival (<60 years: 39.2%; 60-69 years: 29.9%; 70-79 years: 12.3%; ≥80 years: 13.0%, P < 0.0001). Implantation of a ventricular assist device or heart transplant was performed in 3.2% of patients and their 5-year survival was 42.9% (for heart transplant, 63.6%). CONCLUSION: Veno-arterial extracorporeal membrane oxygenation for PCS is associated with satisfactory 5-year survival in young patients without critical pre-ECMO conditions. The use of VA-ECMO for PCS in patients >70 years should be considered only after a judicious scrutiny of patient's life expectancy. Future studies should evaluate whether satisfactory mid-term survival of these patients translates into a good functional outcome. TRIAL REGISTRATION: Clinicaltrials.gov-NCT03508505.

Cardiothoracic Department University Hospital of Udine Udine Italy

Department of Cardiac Surgery Karolinska Institutet Karolinska University Hospital Stockholm Sweden

Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden

Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow UK

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 Intensive Care Medicine and Cardiac Surgery Glenfield Hospital University Hospitals of Leicester Leicester UK

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

Department of Surgery University of Turku Turku Finland

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

Heart and Lung Center Helsinki University Hospital Haartmaninkatu 4 P O Box 340 00029 Helsinki Finland

Institute of Clinical and Experimental Medicine Prague Czech Republic

Prince Sultan Cardiac Center Al Hassa Saudi Arabia

Research Unit of Surgery Anesthesiology and Critical Care Faculty of Medicine University of Oulu Oulu Finland

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

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ClinicalTrials.gov
NCT03508505