OBJECTIVES: Age is the main determinant for mortality in patients requiring postcardiotomy extracorporeal membrane oxygenation (PC-ECMO), but strategies to reverse this trend are unknown. This study investigates PC-ECMO outcomes in older patients (≥70 years) compared with younger patients (<70 years). METHODS: This retrospective study included patients who required PC-ECMO between 2000 and 2020. Variables independently associated with in-hospital mortality were identified using mixed Cox proportional hazards models. RESULTS: The study included 2057 patients (mean age: 62.3 [first and third quartile: 19-94]; male patients: n = 1213 [59%]): 1376 (67%) were <70 years and 680 (33%) were ≥70 years old. Older patients had more preoperative comorbidities, whereas younger patients had lower cardiac function and more preoperative intubation and vasopressor use. In-hospital mortality was 56.3% (n = 775) and 68.8% (n = 468) in the <70 year and ≥70 year groups, respectively (P < .001). The 7-year postdischarge survival rate was greater for the younger patient group (P < .001). Variables associated with in-hospital mortality in older patients were previous stroke (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.05-1.84), preoperative right ventricular failure (HR, 1.45; 95% CI, 1-2.1), aortic surgery (HR 1.65; 95% CI, 1.2-2.2), and postoperative complications including bleeding (HR 1.24; 95% CI, 1.0-1.5), cardiac arrest (HR, 1.65; 95% CI, 1.3-2.1), and right ventricular failure (HR, 1.29; 95% CI, 1.0-1.6). CONCLUSIONS: PC-ECMO mortality is high in older patients. Preoperative factors including previous stroke and right ventricular failure and postoperative factors including bleeding, cardiac arrest, and right ventricular failure should be targeted to reduce in-hospital mortality after appropriate initial selection in older patients.

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 and UQ Northside Clinic Unite Faculty of Medicine The University of Queensland Brisbane Australia

Cardiac Intensive Care Unit Johns Hopkins Hospital Baltimore Md

Cardiac Surgery Department Rambam Medical Centre Haifa Israel

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 Department of Precision Medicine in Medical Surgical and Critical Area University of Palermo Palermo Italy

Cardiac Surgery Unit IRCCS Humanitas Research Hospital Rozzano Milan Italy

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

Cardiothoracic Intensive Care Unit National University Hospital Singapore

Care and Public Health Research Institute Maastricht University Maastricht The Netherlands

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

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

Department of Cardiac Surgery Karl Landsteiner University University Clinic St Pölten St Pölten Austria

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 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 Erasmus MC Rotterdam The Netherlands

Department of Cardiology Fundación Cardiovascular de Colombia Bucaramanga Colombia

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 and Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Department of Intensive Care Medicine St Vincent's Hospital Sydney Australia

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 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

Heart Center Niederrhein Helios Hospital Krefeld Krefeld Germany

Intensive Care Unit The Alfred Hospital Melbourne Victoria Australia

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

Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy

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

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