BACKGROUND: Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation. METHODS: This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models. RESULTS: The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; P < .001) and aortic procedures (n = 126; 23.9%; P = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; P < .001). Postoperative bleeding (n = 338; 64.3%; P < .001), stroke (n = 79; 15%; P < .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (P = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; P = .039) and dropped to 1.09 (95% CI, 0.93-1.27; P = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (P = .083). CONCLUSIONS: One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.

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 Australia

Cardiac Intensive Care Unit Johns Hopkins Hospital Baltimore Md

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

Cardiac Surgery Unit Cardio thoracic and Vascular Department Fondazione IRCCS San Gerardo dei Tintori Monza Italy

Cardiac Surgery Unit IRCCS Humanitas Research Hospital Rozzano Italy

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

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

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

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

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 Cardiology Fundación Cardiovascular de Colombia Bucaramanga Colombia

Department of Cardiothoracic Surgery University Hospital Henri Mondor Créteil Paris France

Department of Cardiothoracic Surgery University Medical Center Regensburg Regensburg Germany

Department of Cardiovascular Sciences University Hospitals Leuven Leuven Belgium

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Intensive Care Adults and Department of Cardiology Thoraxcenter Erasmus MC Rotterdam The Netherlands

Department of Intensive Care Medicine Center of Applied Medical Research St Vincent's Hospital Darlinghurst and University of New South Wales Sidney Australia

Department of Medicine and Surgery University of Parma Cardiac Surgery Unit University Hospital 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 Fla

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 Departamento de Anestesia Clínica Las Condes Las Condes Santiago Chile

Intensive Care Unit The Alfred Hospital Melbourne Victoria Australia

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

Leipzig Heart Center Leipzig Klinikum Links der Weser Bremen Germany

Maastricht University Medical Center Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy

Transplant Center of the Heart Institute at the Clinics Hospital of the Medical School of University of São Paulo Sao Paulo Brazil

University of Turin Turin Italy

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