Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation

Area of Science:

• Cardiology
• Cardiothoracic Surgery
• Intensive Care Medicine

Background:

• Post-cardiac surgery cardiopulmonary failure often necessitates mechanical circulatory support.
• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a critical intervention for severe cases.
• Identifying mortality risk factors is crucial for patient management and outcomes.

Purpose of the Study:

• To identify independent risk factors for early mortality in patients undergoing postcardiotomy VA-ECMO.
• To develop a predictive score for hospital mortality after postcardiotomy VA-ECMO.
• To evaluate the impact of center experience on patient outcomes.

Main Methods:

• Retrospective multicenter cohort study of 781 adult patients requiring VA-ECMO post-cardiac surgery (2010-2018).
• Analysis of clinical data to identify predictors of hospital and 1-year mortality.
• Development and validation of the Postcardiotomy ECMO Score based on pre-VA-ECMO variables.

Main Results:

• Overall hospital and 1-year mortality rates were 64.4% and 67.2%.
• Independent predictors of increased hospital mortality included female gender, advanced age, prior cardiac surgery, high pre-VA-ECMO lactate, aortic arch surgery, and preoperative neurological events.
• Higher volume centers (>50 patients) demonstrated significantly lower hospital mortality (60.7% vs. 70.7%).
• The Postcardiotomy ECMO Score effectively stratified mortality risk, with rates ranging from 45.6% (0 points) to 89.7% (≥7 points).

Conclusions:

• Age, female gender, prior cardiac surgery, preoperative neurological events, aortic arch surgery, and elevated lactate are significant risk factors for early mortality.
• The developed Postcardiotomy ECMO Score provides a valuable tool for risk stratification.
• Increased center experience with postcardiotomy VA-ECMO appears to be associated with improved patient survival.