OBJECTIVE: Data on patients requiring a second run of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in patients affected by postcardiotomy cardiogenic shock (PCS) are very limited. The authors aimed to investigate the effect of a second run of VA-ECMO on PCS patient survival. DESIGN: Retrospective analysis of an international registry. SETTING: Multicenter study, tertiary university hospitals. PARTICIPANTS: Data on adult PCS patients receiving a second run of VA-ECMO. MEASUREMENTS AND MAIN RESULTS: A total of 674 patients with a mean age of 62.9 ± 12.7 years were analyzed, and 21 (3.1%) patients had a second run of VA-ECMO. None of them required more than two VA-ECMO runs. The median duration of VA-ECMO therapy was 135 hours (interquartile range [IQR] 61-226) in patients who did not require a VA-ECMO rerun. In the rerun VA-ECMO group the median overall duration of VA-ECMO therapy was 183 hours (IQR 107-344), and the median duration of the first run was 114 hours (IQR 66-169). Nine (42.9%) of the patients who required a second run of VA-ECMO died during VA-ECMO therapy, whereas five (23.8%) survived to hospital discharge. No differences between patients treated with single or second VA-ECMO runs were observed in terms of hospital mortality and late survival. In patients requiring a second VA-ECMO run, the actuarial survival estimates at three and 12 months after VA-ECMO weaning were 23.8% ± 9.3% and 19.6% ± 6.4%, respectively. CONCLUSIONS: Repeat VA-ECMO therapy is a valid treatment strategy for PCS patients. Early and late survivals are similar between patients who have undergone a single or second run of VA-ECMO.

Cardiac Surgery S Anna Hospital Catanzaro Italy

Cardiothoracic Department University Hospital of Udine Udine Italy

Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden

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 Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Intensive Care Medicine and Cardiac Surgery Glenfield Hospital University Hospitals of Leicester NHS Trust Leicester United Kingdom

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 IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Division of Cardiac Surgery Ospedali Riuniti Trieste Italy

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

Hamburg University Heart Center Hamburg Germany; Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

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; Department of Surgery University of Turku Turku Finland; Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

Research Unit of Surgery Anesthesiology and Critical Care Faculty of Medicine University of Oulu Oulu Finland; Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

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