Patients Post Cardiac Surgery Requiring Venoarterial Extracorporeal Membrane Oxygenation: Outcomes From an Intensivist-Led Extracorporeal Membrane Oxygenation Program

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Post cardiac surgery shock (PCS) is a life-threatening condition that may require the use of mechanical circulatory support. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is increasingly used to treat refractory PCS. We conducted a single-center, retrospective observational cohort study of adult PCS patients treated with VA-ECMO by an intensivist-led ECMO service from 2014 to 2023. Patients requiring extracorporeal cardiopulmonary resuscitation or venovenous (VV) ECMO were excluded. Baseline characteristics, ECMO support details, and outcomes were analyzed. The primary outcome was survival to hospital discharge. Multivariate regression was used to identify independent predictors of mortality. A total of 161 patients were included. The median age was 63 years and 68.3% were male. Extracorporeal membrane oxygenation was initiated peripherally in 90% of cases, with a median duration of support of 7 days. Extracorporeal membrane oxygenation weaning was achieved in 60.9% and survival to hospital discharge was 50.9%. The most common complications included renal replacement therapy (46%), left ventricular unloading (40.4%), pericardial tamponade requiring surgical intervention (34%), and neurological events (14.9%). Survival rates in this cohort were higher than those reported in previous multicenter studies, despite frequent complications. Age and total length of stay (LOS) were independent predictors of mortality, highlighting the need for optimized post-ECMO care strategies.

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