• Silvia Mariani, Bas C T van Bussel, Justine M Ravaux, Maaike M Roefs, Maria Elena De Piero, Michele Di Mauro, Anne Willers, Patrique Segers, Thijs Delnoij, van der HorstIwan C CICCCardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands., Jos Maessen, Roberto Lorusso, and Netherlands Heart Registration Cardiothoracic Surgery Registration Committee.
• Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. Electronic address: s.mariani1985@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2023 Mar 1; 165 (3): 11271137.e141127-1137.e14.

ObjectivesExtracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock has been increasingly used without concomitant mortality reduction. This study aims to investigate determinants of in-hospital and postdischarge mortality in patients requiring postcardiotomy ECMO in the Netherlands.MethodsThe Netherlands Heart Registration collects nationwide prospective data from cardiac surgery units. Adults receiving intraoperative or postoperative ECMO included in the register from January 2013 to December 2019 were studied. Survival status was established through the national Personal Records Database. Multivariable logistic regression analyses were used to investigate determinants of in-hospital (3 models) and 12-month postdischarge mortality (4 models). Each model was developed to target specific time points during a patient's clinical course.ResultsOverall, 406 patients (67.2% men, median age, 66.0 years [interquartile range, 55.0-72.0 years]) were included. In-hospital mortality was 51.7%, with death occurring in a median of 5 days (interquartile range, 2-14 days) after surgery. Hospital survivors (n = 196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalization of median 29 days (interquartile range, 17-51 days). Older age (odds ratio [OR], 1.02; 95% CI, 1.0-1.04) and preoperative higher body mass index (OR, 1.08; 95% CI, 1.02-1.14) were associated with in-hospital death. Within 12 months after discharge, 35.1% of hospital survivors (n = 63) died. Postoperative renal failure (OR, 2.3; 95% CI, 1.6-4.9), respiratory failure (OR, 3.6; 95% CI, 1.3-9.9), and re-thoracotomy (OR, 2.9; 95% CI, 1.3-6.5) were associated with 12-month postdischarge mortality.ConclusionsIn-hospital and postdischarge mortality after postcardiotomy ECMO in adults remains high in the Netherlands. ECMO support in patients with higher age and body mass index, which drive associations with higher in-hospital mortality, should be carefully considered. Further observations suggest that prevention of re-thoracotomies, renal failure, and respiratory failure are targets that may improve postdischarge outcomes.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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