How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis

Fausto Biancari¹, Timo Mäkikallio², Camilla L'Acqua^{3

4}, Vito G Ruggieri⁵, Sung-Min Cho⁶, Magnus Dalén⁷, Henryk Welp⁸, Kristján Jónsson⁹, Sigurdur Ragnarsson¹⁰, Francisco J Hernández Pérez¹¹, Giuseppe Gatti¹², Khalid Alkhamees¹³, Antonio Loforte¹⁴, Andrea Lechiancole¹⁵, Paola D'Errigo¹⁶, Stefano Rosato¹⁶, Cristiano Spadaccio¹⁷, Matteo Pettinari¹⁸, Antonio Fiore¹⁹, Giovanni Mariscalco²⁰, Andrea Perrotti²¹, Amr A Arafat^{22

23}, Monirah A Albabtain²⁴, Mohammed M AlBarak²⁵, Mohamed Laimoud^{26

27}, Ilija Djordjevic²⁸, Robertas Samalavicius^{29

30}, Marta Alonso-Fernandez-Gatta^{31

32}, Markus J Wilhelm³³, Alexander Kaserer³⁴, Giorgia Bonalumi¹, Tatu Juvonen^{35

36}, Gianluca Polvani^{1

37}

Affiliations

¹ Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
³ Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy.
⁴ Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁵ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France.
⁶ Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany.
⁹ Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁰ Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden.
¹¹ Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain.
¹² Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy.
¹³ Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia.
¹⁴ Department of Surgical Sciences, University of Turin, Turin, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
¹⁶ Center for Global Health, Italian National Institute, Rome, Italy.
¹⁷ Department of Cardiac Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
¹⁸ Cardiac Surgery Unit, Cardiovascular Department, Cliniques Universitaire Saint Luc, Brussel, Belgium.
¹⁹ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
²⁰ Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom.
²¹ Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
²² Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²³ Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
²⁴ Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²⁵ Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²⁶ Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
²⁷ Critical Care Medicine Department, Cairo University, Cairo, Egypt.
²⁸ Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.
²⁹ 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
³⁰ Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania.
³¹ Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.
³² CIBER-CV Instituto de Salud Carlos III, Madrid, Spain.
³³ Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, Zurich, Switzerland.
³⁴ Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
³⁵ Research Unit of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland.
³⁶ Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
³⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 39964235
DOI: 10.1097/CCM.0000000000006618

Meta-Analysis

How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis

Fausto Biancari et al. Crit Care Med. 2025.

. 2025 Apr 1;53(4):e908-e915.

doi: 10.1097/CCM.0000000000006618. Epub 2025 Feb 18.

Authors

Affiliations

¹ Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
³ Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy.
⁴ Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁵ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France.
⁶ Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany.
⁹ Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁰ Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden.
¹¹ Department of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain.
¹² Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy.
¹³ Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia.
¹⁴ Department of Surgical Sciences, University of Turin, Turin, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
¹⁶ Center for Global Health, Italian National Institute, Rome, Italy.
¹⁷ Department of Cardiac Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
¹⁸ Cardiac Surgery Unit, Cardiovascular Department, Cliniques Universitaire Saint Luc, Brussel, Belgium.
¹⁹ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
²⁰ Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom.
²¹ Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
²² Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²³ Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
²⁴ Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²⁵ Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
²⁶ Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
²⁷ Critical Care Medicine Department, Cairo University, Cairo, Egypt.
²⁸ Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.
²⁹ 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
³⁰ Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania.
³¹ Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.
³² CIBER-CV Instituto de Salud Carlos III, Madrid, Spain.
³³ Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, Zurich, Switzerland.
³⁴ Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
³⁵ Research Unit of Surgery, Anesthesiology and Intensive Care, University of Oulu, Oulu, Finland.
³⁶ Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
³⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 39964235
DOI: 10.1097/CCM.0000000000006618

Abstract

Objectives: To investigate the optimal duration of venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock refractory to medical therapies after cardiac surgery and whether its prolonged use is justified.

Data sources: Previously published articles on postcardiotomy venoarterial ECMO.

Study selection: Articles reporting on the early outcome after postcardiotomy venoarterial ECMO in adult patients were identified through a systematic review of the literature.

Data extraction: Data on prespecified patients' characteristics, operative variables, and outcomes were provided by the authors of previous studies on this topic.

Data synthesis: Individual data of 1267 patients treated at 25 hospitals from ten studies were included in this meta-analysis. In-hospital mortality rates were lowest among patients treated 3-6 days with venoarterial ECMO. Multilevel mixed-effects logistic regression considering the cluster effect of the participating hospitals adjusted for individual patient's risk profile and operative variables showed that the risk in-hospital mortality did not significantly increase in patients treated more than 6 days up to 20 days.

Conclusions: The present study demonstrated that prolonged venoarterial ECMO support after adult cardiac surgery may be justified. However, the analysis was limited by the knowledge of only those circumstances known at the start of ECMO.

Keywords: cardiac surgery; extracorporeal life support; extracorporeal membrane oxygenation; postcardiotomy; risk factors.

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Conflict of interest statement

Dr. Biancari’s institution received funding from the Italian Ministry of Health—Ricerca Corrente to Centro Cardiologico Monzino (IRCCS). Drs. Biancari and Polvani received support for article research form the IRCCS. Dr. Cho received support for article research from the National Institutes of Health/National Heart, Lung, and Blood Institute K23HL157610 and Hyperfine for Safe and Feasibility (SAFE) MRI Extracorporeal Membrane Oxygenation study. Dr. Pérez received funding from Abbott and Abiomed. Dr. Kaserer received funding from Bayer AG (Switzerland), CSL Behring GmbH, AstraZeneca AG, and Pharmacosmos. Dr. Bonalumi received funding from the IRCCS. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Kowalewski M, Zieliński K, Brodie D, et al.: Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock-analysis of the extracorporeal life support organization registry. Crit Care Med. 2021; 49:1107–1117
1. Biancari F, Dalén M, Fiore A, et al.; PC-ECMO Study Group: Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2020; 159:1844–1854.e6
1. Mariani S, Schaefer AK, van Bussel BCT, et al.; PELS Investigators: On-support and postweaning mortality in postcardiotomy extracorporeal membrane oxygenation. Ann Thorac Surg. 2023; 116:1079–1089
1. Burgos LM, Seoane L, Diez M, et al.: Multiparameters associated to successful weaning from VA ECMO in adult patients with cardiogenic shock or cardiac arrest: Systematic review and meta-analysis. Ann Card Anaesth. 2023; 26:4–11
1. Mariscalco G, El-Dean Z, Yusuff H, et al.; PC-ECMO Group: Duration of venoarterial extracorporeal membrane oxygenation and mortality in postcardiotomy cardiogenic shock. J Cardiothorac Vasc Anesth. 2021; 35:2662–2668

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How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis

Affiliations

How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

References

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Medical