• BungeJeroen J HJJH0000-0002-7897-4628Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands.Deparment of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands., Silvia Mariani, Christiaan Meuwese, Bas C T van Bussel, Michele Di Mauro, Dominik Wiedeman, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Hergen Buscher, Leonardo Salazar, Bart Meyns, Daniel Herr, Sacha Matteucci, Sandro Sponga, Graeme MacLaren, Claudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I-Wen Wang, Jae-Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P Garcia, Kiran Shekar, WhitmanGlenn J RGJRCardiac ICU, Johns Hopkins Hospital, Baltimore, MD., Diederik Gommers, Dinis Dos Reis Miranda, Roberto Lorusso, and Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators.
• Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands.
• Crit. Care Med. 2024 Oct 1; 52 (10): e490e502e490-e502.

ObjectivesMost post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO.DesignRetrospective observational cohort study.SettingThirty-four centers from 16 countries between January 2000 and December 2020.PatientsAdults requiring post PC ECMO between 2000 and 2020.InterventionsNone.Measurements And Main ResultsCharacteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days ( n = 649 [32.1%]), 4-7 days ( n = 776 [38.3%]), 8-10 days ( n = 263 [13.0%]), and greater than 10 days ( n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days ( n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support ( n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival.ConclusionsNearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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