Outcomes in Adult Patients Requiring Multiple Runs of Extracorporeal Membrane Oxygenation

This study describes a single-institution experience of adult patients supported with multiple runs of extracorporeal membrane oxygenation (ECMO) during the same hospitalization. We aim to assess complication and survival rates and to identify factors associated with positive outcomes.

Retrospective chart review of patients in a quaternary care center treated with multiple runs of ECMO to assess outcomes and survival to hospital discharge and 1 year.

A single quaternary care academic center.

Forty-six patients, 18 years of age or older, supported with multiple runs of ECMO (venoarterial or venovenous) during the same hospitalization.

None, retrospective chart review.

Of the 451 patients reviewed, 46 (10.1%) underwent multiple runs of ECMO. Forty-four patients required two runs, and two patients required three runs. Indications for initial ECMO support were postcardiotomy cardiogenic shock (72%), cardiogenic shock (24%), and refractory hypoxia (2%). Forty-three patients (93%) were cannulated for venoarterial ECMO during the first run. Ten patients (21.7%) survived to 90 days and hospital discharge, and 9 (19.5%) survived to ≥1 year. Four factors were associated with poor outcomes: acute renal failure during the first ECMO run, postcardiotomy cardiogenic shock as the indication for first cannulation, right ventricular systolic dysfunction prior to first cannulation, and age ≥40 years.

Acute renal failure, postcardiotomy cardiogenic shock, age >40 years, and preexisting right ventricular systolic dysfunction predict poor survival rates. Patients <35 years with congenital heart disease are especially good candidates for multiple ECMO run support.