Outcome of Repeat Veno-Arterial Extracorporeal Membrane Oxygenation in Postcardiotomy Cardiogenic Shock

Abstract Objective Data on patients requiring a second run of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in patients affected by postcardiotomy cardiogenic shock (PCS) is very limited. We aimed to investigate the impact of a second run of VA-ECMO on PCS patient survival. Design Retrospective analysis of an international registry. Setting Multicenter study, tertiary university hospitals. Participants Data on adult PCS patients receiving a second run of VA-ECMO. Measurements and Main Results A total of 674 patients with a mean age 62.9 ± 12.7 of years were analysed, and 21 (3.1%) patients had a second run of VA-ECMO. None of them required more than two VA-ECMO runs. The median duration of VA-ECMO therapy was 135 hours (IQR 61-226) in patients who did not require VA-ECMO rerun. In the rerun VA-ECMO group the median overall duration of VA-ECMO therapy was 183 hours (IQR 107-344), while the median duration of the first run was 114 hours (IQR 66-169). Nine (42.9%) of the patients who required a second run of VA-ECMO died on VA-ECMO therapy, while 5 (23.8%) survived to hospital discharge. No differences between patients treated with single or second VA-ECMO runs were observed in terms of hospital mortality and late survival. In patients requiring a second VA-ECMO run, the actuarial survival estimates at 3 and 12 months after VA-ECMO weaning were 23.8% ± 9.3%, and 19.6% ± 6.4%, respectively. Conclusions Repeat VA-ECMO therapy is a valid treatment strategy for PCS patients. Early and late survivals are similar between patients have undergone single or second run of VA-ECMO.