Central Veno-Arterial Extracorporeal Membrane Oxygenation (C-VA-ECMO) After Cardiothoracic Surgery: A Single-Center Experience

Objectives: Central veno-arterial extracorporeal membrane oxygenation (C-VA-ECMO) provides temporary cardiorespiratory support for patients in heart failure who cannot be weaned from cardiopulmonary bypass successfully. Outcomes are influenced by the reversibility of the initial insult and complications of the technique. Methods: The authors reviewed their single-center experience over the last 8 years to inform future practice. The study included all patients supported with C-VA-ECMO after cardiothoracic surgery between January 2008 and July 2016. The authors identified mortality risk factors using logistic regression analysis and chi-square tests. Results: One hundred and one patients were supported with C-VA-ECMO during the studied period. Weaning from ECMO was successful in 57.4% of patients, whereas 7.9% were bridged to veno-venous ECMO, 2% to peripheral veno-arterial ECMO, and 2% to biventricular ventricular assist devices. In-hospital and 1-year survival for all patients was 33.7% and 27.7%, respectively. Survival was considerably higher in transplantation patients (n = 11), at 63.6% and 54.5%, respectively. Risk factors linked to in-hospital mortality were age older than 70 years, lactate level greater than 4 mmol/L after 48 hours, and hepatic and kidney failure during ECMO support. Conclusions: Overall one-third of patients in the cohort who the authors believe would otherwise have died from postcardiotomy cardiogenic shock survived because C-VA-ECMO was commenced after cardiac surgery. Survival is greater in transplantation patients necessitating this form of support during or immediately after surgery. (C) 2017 Elsevier Inc. All rights reserved.