Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study

Ary Serpa Neto^{1

2

3}, Alisa M Higgins¹, Michael J Bailey^{1

2}, Shannah Anderson¹, Stephen Bernard^{4

5}, Bentley J Fulcher¹, Annalie Jones⁵, Natalie J Linke¹, Jasmin V Board⁵, Daniel Brodie⁶, Heidi Buhr⁷, Aidan J C Burrell^{1

5}, D James Cooper^{1

5}, Eddy Fan⁸, John F Fraser^{9

10}, David J Gattas⁷, Ingrid K Hopper⁴, Sue Huckson¹¹, Edward Litton¹², Shay P McGuinness^{1

13

14}, Priya Nair¹⁵, Neil Orford^{1

16

17}, Rachael L Parke^{1

13

14}, Vincent A Pellegrino⁵, David V Pilcher^{1

5}, Craig Dicker¹, Benjamin A J Reddi¹⁸, Dion Stub^{4

5}, Tony V Trapani¹, Andrew A Udy^{1

5}, Carol L Hodgson^{1

2

5}; EXCEL Study Investigators on behalf of the International ECMO Network (ECMONet)

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.), School of Public Health and Preventive Medicine.
² Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, VIC, Australia (A.S.N., M.J.B., C.L.H.).
³ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil (A.S.N.).
⁴ Monash University, Melbourne, VIC, Australia (S.B., I.K.H., D.S.).
⁵ Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.).
⁶ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.B.).
⁷ Intensive Care Service, Royal Prince Alfred Hospital, Melbourne, VIC, Australia (H.B., D.J.G.).
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (E.F.).
⁹ University of Queensland, Brisbane, QLD, Australia (J.F.F.).
¹⁰ Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Brisbane, QLD, Australia (J.F.F.).
¹¹ Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia (S.H.).
¹² Intensive Care Unit, Fiona Stanley Hospital, Melbourne, VIC, Australia (E.L.).
¹³ Medical Research Institute of New Zealand, Wellington (S.P.M.G., R.L.P.).
¹⁴ Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand (S.P.M.G., R.L.P.).
¹⁵ Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia (P.N.).
¹⁶ Intensive Care Unit, University Hospital Geelong, Melbourne, VIC, Australia (N.O.).
¹⁷ School of Medicine, Deakin University, Melbourne, VIC, Australia (N.O.).
¹⁸ Intensive Care Unit, Royal Adelaide Hospital, Melbourne, VIC, Australia (B.A.J.R.).

PMID: 40298907
DOI: 10.1161/CIRCHEARTFAILURE.124.012476

Observational Study

Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study

Ary Serpa Neto et al. Circ Heart Fail. 2025 Jun.

. 2025 Jun;18(6):e012476.

doi: 10.1161/CIRCHEARTFAILURE.124.012476. Epub 2025 Apr 29.

Authors

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.), School of Public Health and Preventive Medicine.
² Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, VIC, Australia (A.S.N., M.J.B., C.L.H.).
³ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil (A.S.N.).
⁴ Monash University, Melbourne, VIC, Australia (S.B., I.K.H., D.S.).
⁵ Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.).
⁶ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.B.).
⁷ Intensive Care Service, Royal Prince Alfred Hospital, Melbourne, VIC, Australia (H.B., D.J.G.).
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (E.F.).
⁹ University of Queensland, Brisbane, QLD, Australia (J.F.F.).
¹⁰ Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Brisbane, QLD, Australia (J.F.F.).
¹¹ Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia (S.H.).
¹² Intensive Care Unit, Fiona Stanley Hospital, Melbourne, VIC, Australia (E.L.).
¹³ Medical Research Institute of New Zealand, Wellington (S.P.M.G., R.L.P.).
¹⁴ Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand (S.P.M.G., R.L.P.).
¹⁵ Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia (P.N.).
¹⁶ Intensive Care Unit, University Hospital Geelong, Melbourne, VIC, Australia (N.O.).
¹⁷ School of Medicine, Deakin University, Melbourne, VIC, Australia (N.O.).
¹⁸ Intensive Care Unit, Royal Adelaide Hospital, Melbourne, VIC, Australia (B.A.J.R.).

PMID: 40298907
DOI: 10.1161/CIRCHEARTFAILURE.124.012476

Abstract

Background: Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.

Methods: Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation.

Results: Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% women), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; P=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; P=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; P<0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation.

Conclusions: At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03793257.

Keywords: adult; humans; incidence; odds ratio; quality of life.

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Conflict of interest statement

Dr Serpa Neto reported receiving personal fees from Drager. Dr Hodgson leads the binational EXCEL registry (Australian and New Zealand Extracorporeal Membrane Oxygenation [ECMO] Registry), with funding from the Australian National Health and Medical Research Council (NHMRC) and the Heart Foundation of Australia (HFA), holds an NHMRC investigator grant, and is on the executive committee of the International ECMO Network (ECMONet). Drs Serpa Neto, Higgins, Burrell, and Cooper receive research support from NHMRC. Drs Higgins, Bailey, Bernard, Fulcher, Cooper, Hopper, Pilcher, and Udy and N.J. Linke, D.J. Gattas, and T.V. Trapani received funding for the EXCEL registry from NHMRC and HFA. Dr Brodie is Chair of the Executive Committee of ECMONet and President-elect of ELSO, receives research support from ALung Technologies, and has been on medical advisory boards for Abiomed, Xenios, Medtronic, and Cellenkos. Dr Cooper holds an NHMRC practitioner fellowship. Dr Fan is on the executive committee of ECMONet and the steering committee of the Extracorporeal Life Support Organization (ELSO). Drs Fraser and Pellegrino are on the Executive Committee of ECMONet. Dr Fraser is President of the Asia-Pacific Chapter of ELSO, Chair of the Queensland Cardiovascular Research Network, co-founder of BiVACOR, and receives research support from Xenios, Mallenkrodt Getinge, and MERA (all ECMO companies). Dr Stub received research support from an HFA fellowship. Dr Udy is on the executive committee of the Australian and New Zealand Intensive Care Society Clinical Trials Group. The other authors report no conflicts.

Comment in

Forgotten After Discharge? ECMO Patients Deserve Better.
Modi SP, Kanwar MK. Modi SP, et al. Circ Heart Fail. 2025 Jun;18(6):e013176. doi: 10.1161/CIRCHEARTFAILURE.125.013176. Epub 2025 May 29. Circ Heart Fail. 2025. PMID: 40438938 No abstract available.

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Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study

Affiliations

Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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Associated data

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Medical

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