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Observational Study
. 2024 Oct 1;52(10):e490-e502.
doi: 10.1097/CCM.0000000000006349. Epub 2024 Jun 7.

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Jeroen J H Bunge  1   2 , Silvia Mariani  3 , Christiaan Meuwese  1   2 , Bas C T van Bussel  4 , Michele Di Mauro  5 , Dominik Wiedeman  6   7 , Diyar Saeed  8 , Matteo Pozzi  9 , Antonio Loforte  10   11 , Udo Boeken  12 , Robertas Samalavicius  13 , Karl Bounader  14 , Xiaotong Hou  15 , Hergen Buscher  16 , Leonardo Salazar  17 , Bart Meyns  18 , Daniel Herr  19 , Sacha Matteucci  20 , Sandro Sponga  21 , Graeme MacLaren  22 , Claudio Russo  23 , Francesco Formica  24   25   26 , Pranya Sakiyalak  27 , Antonio Fiore  28 , Daniele Camboni  29 , Giuseppe Maria Raffa  30 , Rodrigo Diaz  31 , I-Wen Wang  32 , Jae-Seung Jung  33 , Jan Belohlavek  34 , Vin Pellegrino  35 , Giacomo Bianchi  36 , Matteo Pettinari  37 , Alessandro Barbone  38 , José P Garcia  39 , Kiran Shekar  40 , Glenn J R Whitman  41 , Diederik Gommers  1 , Dinis Dos Reis Miranda  1 , Roberto Lorusso  3 ; Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators
Collaborators, Affiliations
Observational Study

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Jeroen J H Bunge et al. Crit Care Med. .

Abstract

Objectives: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO.

Design: Retrospective observational cohort study.

Setting: Thirty-four centers from 16 countries between January 2000 and December 2020.

Patients: Adults requiring post PC ECMO between 2000 and 2020.

Interventions: None.

Measurements and main results: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days ( n = 649 [32.1%]), 4-7 days ( n = 776 [38.3%]), 8-10 days ( n = 263 [13.0%]), and greater than 10 days ( n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days ( n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support ( n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival.

Conclusions: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

Trial registration: ClinicalTrials.gov NCT03857217.

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Conflict of interest statement

Dr. Wiedemann received funding from Xenios, Fresenius, and Abbott. Dr. Whitman received funding from Avania, LLC. Dr. Miranda received funding from Resuscitec. Dr. Lorusso’s institution received funding from Medtronic, LivaNova, Eurosets, Abiomed, Xenios, Hemocue, ChinaBridge Medical, and Getinge. Dr. MacLaren is the president of the Extracorporeal Life Support Organization. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Short and long-term outcomes of post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) according to ECMO duration groups. A, Stacked bar plots representing mortality while on PC ECMO, in-hospital mortality after PC ECMO explantation, and hospital survival by PC ECMO duration groups. B, Kaplan-Meier survival curves with 95% CIs for the various PC ECMO duration groups, starting at time of ECMO implantation.
Figure 2.
Figure 2.
Kaplan-Meier survival curves with 95% CIs for the various post-cardiotomy extracorporeal membrane oxygenation (ECMO) duration groups. Long-term survival of hospital survivors.
See this image and copyright information in PMC

References

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