OBJECTIVES: To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). DESIGN: A retrospective multicenter registry study. SETTING: At 19 cardiac surgery units. PARTICIPANTS: A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). MEASUREMENTS AND MAIN RESULTS: The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n = 54) in the ECMO-IABP group compared to 27% (n = 132) in the ECMO-only group. In the ECMO-IABP group, 58% (n = 67) were successfully weaned from ECMO, compared to 46% (n = 231) in the ECMO-only group (p = 0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p = 0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p = 0.51) and in-hospital mortality (64% v 58%, p = 0.78). CONCLUSIONS: This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.

Cardiothoracic Department University Hospital of Udine Udine Italy

Clinica Montevergine GVM Care and Research Mercogliano Italy; Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

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

Department of Cardiac Surgery Glenfield Hospital University Hospitals of Leicester NHS Trust 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 Cardiac Surgery Massachusetts General Hospital Harvard Medical School Boston MA

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 Skane University Hospital and Lund University Lund Sweden

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

Department of Cardiovascular Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany

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 Anthea Hospital GVM Care and Research Bari Italy

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

Institute of Clinical and Experimental Medicine Prague Czech Republic

Prince Sultan Cardiac Center Al Hassa Saudi Arabia

J Cardiothorac Vasc Anesth. 2022 Jul;36(7):2246. doi: 10.1053/j.jvca.2022.03.005. PubMed

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