Duration of Veno-Arterial Extracorporeal Membrane Oxygenation and Mortality in Postcardiotomy Cardiogenic Shock

Structured Abstract Objective The optimal duration of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. We aimed to investigate the impact of VA-ECMO duration on hospital outcomes. Design Retrospectiev analysis of an international registry. Setting Multicenter study, 19 tertiary university hospitals. Participants Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicentre PC-ECMO registry. Interventions Patients were stratified according to different duration of VA-ECMO therapy: ≤3 days, 4-7 days, 8-10 days, and >10 days. Measuramenets and Main Results A total of 725 patients with a mean age of 62.9±12.9 years were included. The mean duration of VA-ECMO was 7.1±6.3 days (range: 0-39 days), and 39.4% patients were supported for ≤3 days, 29.1% for 4-7 days, 15.3% for 8-10 days, and finally 20.7% for >10 days. A total of 391 (53.9%) patients were successfully weaned from VA-ECMO while 134 (34.3%) of these died prior to discharge. Multivariable logistic regression showed that prolonged duration of VA-ECMO therapy (4-7 days, adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; 8-10 days, adjusted rate 61.3%,OR 0.51, 95% CI 0.29-0.87; and >10 days, adjusted rate 59.3%,OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤3 days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for 8-10 days (OR 1.96, 95% CI 1.15-3.33) and >10 days (OR 1.85, 95% CI 1.14-3.02) had significantly higher mortality compared to those on VA-ECMO for 4-7 days. Conclusions PCS patients weaned from VA-ECMO after 4 to 7 days of support had significantly lower mortality compared with those with shorter or longer mechanical support. Trial Registration Clinicaltrials.gov - NCT03508505