Multicenter Study on Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Abstract Objectives The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) Methods This is an analysis of the PC-ECMO registry, a retrospective multicenter cohort study including 781 patients aged>18 years who required VA-ECMO for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. Results After a mean VA-ECMO therapy of 6.9±6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after VA-ECMO therapy longer than 7 days was 60.5% (p=0.105). Centers which had treated more than 50 patients with postcardiotomy VA-ECMO had a significantly lower hospital mortality than lower volume centers (60.7% vs. 70.7%, adjusted OR 0.58, 95%CI 0.41-0.82). The PC-ECMO score was derived by assigning a weighted integer to each independent pre-VA-ECMO predictors of hospital mortality as follows: female gender (1 point), advanced age (60-69 years, 2 points; ≥70 years 4 points), prior cardiac surgery (1 point), arterial lactate ≥6.0 mmol/L before VA-ECMO (2 points), aortic arch surgery (4 points) and preoperative stroke/unconsciousness (5 points). The hospital mortality rates according to the PC-ECMO score was: 0 point, 45.6%; 1 point ,40.5%; 2 points 51.1%; 3 points 57.8%; 4 points 70.7%; 5 points 68.3%; 6 points 77.5%; and ≥7 point 89.7% (p Conclusions Age, prior cardiac surgery, preoperative acute neurological events, aortic arch surgery and increased arterial lactate were associated with increased risk of early mortality after postcardiotomy VA-ECMO. Center experience with postcardiotomy VA-ECMO may contribute to improved results.