Clinical Outcomes of Venoarterial Extracorporeal Life Support in 462 Patients: Single-Center Experience

Objectives: This study aimed to investigate the outcomes of venoarterial extracorporeal life support (VA-ECLS) in a large single-center patient cohort regarding survival and adverse events.

Methods: Between June 2009 and March 2019, a total of 462 consecutive patients received VA-ECLS. Mean age was 66.2 ± 11.9 years. Two patient groups were identified: group 1—patients with ECLS due to postcardiotomy shock after cardiac surgery (PCS, n = 357) and group 2—patients with ECLS due to cardiogenic shock (CS) without previous surgery (non-PCS, n = 105). The primary endpoint was overall in-hospital survival; secondary endpoints were adverse events during the study period.

Results: Overall in-hospital survival was 26%, there being no statistically significant difference between the groups: 26.3% for PCS and 24.8% for non-PCS (p > 0.05). Weaning from VA-ECLS was possible in 44.3% for PCS and in 29.5% for non-PCS (p = 0.004). Strong predictors of overall mortality were postoperative hepatic dysfunction (OR = 14.362, 95% CI = 1.948–105.858), cardiopulmonary resuscitation > 30 min (OR = 6.301, 95% CI = 1.488–26.673), bleeding with need for revision (OR = 2.123, 95% CI = 1.343–3.355), and previous sternotomy (OR = 2.077, 95% CI = 1.021–4.223).

Conclusion: Despite its low survival rates, VA-ECLS therapy is the last resort and the only life-saving option for patients in refractory CS. On the other hand, there is still a lack of evidence for VA-ECLS in PCS patients. Future studies are warranted to evaluate the outcomes of VA-ECLS therapy after cardiac surgery.

No conflict of interest has been declared by the author(s).