OBJECTIVES: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO. DESIGN: Retrospective observational cohort study. SETTING: Thirty-four centers from 16 countries between January 2000 and December 2020. PATIENTS: Adults requiring post PC ECMO between 2000 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days ( n = 649 [32.1%]), 4-7 days ( n = 776 [38.3%]), 8-10 days ( n = 263 [13.0%]), and greater than 10 days ( n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days ( n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support ( n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival. CONCLUSIONS: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

2 Department of Anesthesiology Centre of Anesthesia Intensive Care and Pain Management Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania

2nd Department of Internal Medicine Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Adult Intensive Care Services The Prince Charles Hospital Brisbane QLD Australia

Cardiac ICU Johns Hopkins Hospital Baltimore MD

Cardiac Surgery Unit Cardiac Thoracic and Vascular Department Niguarda Hospital Milan Italy

Cardiac Surgery Unit IRCCS Humanitas Research Hospital Rozzano Milan Italy

Cardiac Surgery Unit University Hospital of Parma Parma Italy

Cardio Thoracic Surgery Department and Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Cardiothoracic Intensive Care Unit National University Heart Centre National University Hospital Singapore Singapore

Center for Cardiac Intensive Care Beijing Institute of Heart Lung and Blood Vessels Diseases Beijing Anzhen Hospital Capital Medical University Beijing China

Deparment of Cardiology Thoraxcenter Erasmus MC Rotterdam The Netherlands

Deparment of Surgical Sciences University of Turin Turin Italy

Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS ISMETT Palermo Italy

Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany

Department of Cardiac Surgery Louis Pradel Cardiologic Hospital Lyon France

Department of Cardiac Surgery Medical Faculty Heinrich Heine University Duesseldorf Germany

Department of Cardiac Surgery Medical University of Vienna Vienna Austria

Department of Cardiac Surgery University Hospital St Pölten St Pölten Austria

Department of Cardiac Surgery University Hospitals Leuven and Department of Cardiovascular Sciences University of Leuven Leuven Belgium

Department of Cardio Thoracic Surgery University Hospital Henri Mondor Créteil Paris France

Department of Cardiology Fundación Cardiovascular de Colombia Bucaramanga Colombia

Department of Cardiology Pierangeli Hospital Pescara Italy

Department of Cardiothoracic Surgery University Medical Center Regensburg Regensburg Germany

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Intensive Care Adults Erasmus MC Rotterdam The Netherlands

Department of Intensive Care Medicine Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Department of Intensive Care Medicine Center of Applied Medical Research St Vincent's Hospital University of New South Wales Sydney NSW Australia

Department of Medicine and Surgery Cardiac Surgery Clinic San Gerardo Hospital University of Milano Bicocca Monza Italy

Department of Medicine and Surgery University of Parma Parma Italy

Department of Thoracic and Cardiovascular Surgery Korea University Anam Hospital Seoul South Korea

Departments of Medicine and Surgery University of Maryland Baltimore MD

Division of Cardiac Surgery Cardiothoracic Department University Hospital of Udine Udine Italy

Division of Cardiac Surgery IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Division of Cardiac Surgery Memorial Healthcare System Hollywood FL

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

Division of Cardiovascular and Thoracic Surgery Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand

ECMO Unit Centro Cardiovascular Red Salud Santiago and Hospital San Juan de Dios Santiago Chile

Intensive Care Unit The Alfred Hospital Melbourne VIC Australia

IU Health Advanced Heart and Lung Care Indiana University Methodist Hospital Indianapolis IN

Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy

SOD Cardiochirurgia Ospedali Riuniti Umberto 1 Lancisi Salesi Università Politecnica delle Marche Ancona Italy

Zobrazit více v PubMed

McCarthy FH, McDermott KM, Kini V, et al. : Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002-2012. Semin Thorac Cardiovasc Surg. 2015; 27:81–88 PubMed PMC

Kowalewski M, Zieliński K, Brodie D, et al. : Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock-analysis of the extracorporeal life support organization registry. Crit Care Med. 2021; 49:1107–1117 PubMed PMC

Lorusso R, Whitman G, Milojevic M, et al. : 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. Eur J Cardiothorac Surg. 2021; 59:12–53 PubMed

Biancari F, Dalén M, Fiore A, et al. ; PC-ECMO Study Group: Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2020; 159:1844–1854.e6 PubMed

Rastan AJ, Dege A, Mohr M, et al. : Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010; 139:302–311, 311.e1 PubMed

Lorusso R, Raffa GM, Alenizy K, et al. : Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 1-adult patients. J Heart Lung Transplant. 2019; 38:1125–1143 PubMed PMC

Smith M, Vukomanovic A, Brodie D, et al. : Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: An analysis of the extracorporeal life support organization (ELSO) registry. Crit Care. 2017; 21:45. PubMed PMC

Ortuno S, Delmas C, Diehl JL, et al. : Weaning from veno-arterial extra-corporeal membrane oxygenation: Which strategy to use? Ann Cardiothorac Surg. 2019; 8:E1–E8 PubMed PMC

Mariscalco G, El-Dean Z, Yusuff H, et al. ; PC-ECMO Group: Duration of venoarterial extracorporeal membrane oxygenation and mortality in postcardiotomy cardiogenic shock. J Cardiothorac Vasc Anesth. 2021; 35:2662–2668 PubMed

Distelmaier K, Wiedemann D, Binder C, et al. : Duration of extracorporeal membrane oxygenation support and survival in cardiovascular surgery patients. J Thorac Cardiovasc Surg. 2018; 155:2471–2476 PubMed

Khorsandi M, Dougherty S, Bouamra O, et al. : Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: A systematic review and meta-analysis. J Cardiothorac Surg. 2017; 12:55. PubMed PMC

Slottosch I, Liakopoulos O, Kuhn E, et al. : Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: A single-center experience. J Surg Res. 2013; 181:e47–e55 PubMed

Oude Lansink-Hartgring A, de Vries AJ, Droogh JM, et al. : Hemorrhagic complications during extracorporeal membrane oxygenation—the role of anticoagulation and platelets. J Crit Care. 2019; 54:239–243 PubMed

Quintana MT, Mazzeffi M, Galvagno SM, et al. : A retrospective study of infection in patients requiring extracorporeal membrane oxygenation support. Ann Thorac Surg. 2021; 112:1168–1175 PubMed

Cho SM, Canner J, Chiarini G, et al. : Modifiable risk factors and mortality from ischemic and hemorrhagic strokes in patients receiving venoarterial extracorporeal membrane oxygenation: Results from the extracorporeal life support organization registry. Crit Care Med. 2020; 48:e897–e905 PubMed PMC

Mariani S, Heuts S, van Bussel BCT, et al. ; PELS-1 Investigators*: Patient and management variables associated with survival after postcardiotomy extracorporeal membrane oxygenation in adults: The PELS-1 multicenter cohort study. J Am Heart Assoc. 2023; 12:e029609. PubMed PMC

Heuts S, Mariani S, van Bussel BCT, et al. ; PELS-1 Investigators: The relation between obesity and mortality in postcardiotomy venoarterial membrane oxygenation. Ann Thorac Surg. 2023; 116:147–154 PubMed

Mariani S, Schaefer AK, van Bussel BCT, et al. : On-support and post-weaning mortality in post-cardiotomy extracorporeal membrane oxygenation. Ann Thorac Surg. 2023; 116:1079–1089 PubMed

Mariani S, Wang IW, van Bussel BCT, et al. ; PELS-1 (PELS-1, Post-Cardiotomy Extracorporeal Life Support Study) Investigators: The importance of timing in postcardiotomy venoarterial extracorporeal membrane oxygenation: A descriptive multicenter observational study. J Thorac Cardiovasc Surg. 2023; 166:1670–1682.e33 PubMed

Thabane L, Mbuagbaw L, Zhang S, et al. : A tutorial on sensitivity analyses in clinical trials: The what, why, when and how. BMC Med Res Methodol. 2013; 13:92. PubMed PMC

Ko WJ, Lin CY, Chen RJ, et al. : Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002; 73:538–545 PubMed

Fiser SM, Tribble CG, Kaza AK, et al. : When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001; 71:210–214 PubMed

Fernando SM, Qureshi D, Tanuseputro P, et al. : Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: A population-based cohort study. Intensive Care Med. 2019; 45:1580–1589 PubMed

Dhamija A, Thibault D, Fugett J, et al. : Incremental effect of complications on mortality and hospital costs in adult ECMO patients. Perfusion. 2022; 37:461–469 PubMed

Schmidt M, Bréchot N, Hariri S, et al. : Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis. 2012; 55:1633–1641 PubMed PMC

Mashiko Y, Abe T, Tokuda Y, et al. : Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: Predictors of in-hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. J Artif Organs. 2020; 23:225–232 PubMed

Meuwese CL, Brodie D, Donker DW: The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation. Crit Care. 2022; 26:216. PubMed PMC

Simons J, Suverein M, van Mook W, et al. : Do-(not-)mechanical-circulatory-support orders: Should we ask all cardiac surgery patients for informed consent for post-cardiotomy extracorporeal life circulatory support? J Clin Med. 2021; 10:383. PubMed PMC

Schaefer AK, Riebandt J, Bernardi MH, et al. : Fate of patients weaned from post-cardiotomy extracorporeal life support. Eur J Cardiothorac Surg. 2022; 61:1178–1185 PubMed

Zobrazit více v PubMed

ClinicalTrials.gov
NCT03857217