Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS‐1 Multicenter Cohort Study
Authors: Mariani Silvia , Heuts Samuel , van Bussel Bas C. T. , Di Mauro Michele , Wiedemann Dominik , Saeed Diyar , Pozzi Matteo , Loforte Antonio , Boeken Udo , Samalavicius Robertas , Bounader Karl , Hou Xiaotong , Bunge Jeroen J. H. , Buscher Hergen , Salazar Leonardo , Meyns Bart , Herr Daniel , Matteucci Marco L. Sacha , Sponga Sandro , MacLaren Graeme , Russo Claudio , Formica Francesco , Sakiyalak Pranya , Fiore Antonio , Camboni Daniele , Raffa Giuseppe Maria , Diaz Rodrigo , Wang I‐wen , Jung Jae‐Seung , Belohlavek Jan , Pellegrino Vin , Bianchi Giacomo , Pettinari Matteo , Barbone Alessandro , Garcia José P. , Shekar Kiran , Whitman Glenn J. R. , Lorusso Roberto , Ravaux Justine , Schaefer Anne‐Kristin , Conci Luca , Szalkiewicz Philipp , Khalil Jawad , Lehmann Sven , Obadia Jean‐Francois , Kalampokas Nikolaos , Flecher Erwan , Miranda Dinis Dos Reis , Sriranjan Kogulan , Mazzeffi Michael A. , Vedadi Nazli , Di Eusanio Marco , Sorokin Vitaly , Ramanathan Kollengode , Costetti Alessandro , Schmid Chistof , Castillo Roberto , Mikulenka Vladimir , Solinas Marco 
Published: July 2023

Background
Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in‐hospital mortality. Long‐term outcomes are unknown. This study describes patients’ characteristics, in‐hospital outcome, and 10‐year survival after postcardiotomy ECMO. Variables associated with in‐hospital and postdischarge mortality are investigated and reported.

Methods and Results
The retrospective international multicenter observational PELS‐1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow‐up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0–72.0] years). In‐hospital mortality was 60.5%. Independent variables associated with in‐hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01–1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15–1.73]). In the subgroup of hospital survivors, the overall 1‐, 2‐, 5‐, and 10‐year survival rates were 89.5% (95% CI, 87.0%–92.0%), 85.4% (95% CI, 82.5%–88.3%), 76.4% (95% CI, 72.5%–80.5%), and 65.9% (95% CI, 60.3%–72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock.

Conclusions
In adults, in‐hospital mortality after postcardiotomy ECMO remains high; however, two‐thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03857217.