(152) Post-Cardiotomy Patients Requiring VA ECMO: Outcomes From an Intensivist-Led ECMO Program

Introduction: Post-cardiotomy cardiogenic shock (PCCS) is a life-threatening complication post cardiac surgery. Extracorporeal membrane oxygenation (ECMO) represents the mainstay of acute mechanical circulatory support (MCS) for PCCS.

Methods: A retrospective chart review of all post-cardiotomy patients requiring venoarterial (VA) ECMO from 10/2014 to 12/31/2023 was performed. Baseline demographics and ECMO-specific data was collected. Additional variables included complications, hospital length of stay, disposition, and mortality.

Results: Since program inception, 142 post-cardiotomy patients were placed on VA ECMO. Patients that were cannulated during cardiopulmonary resuscitation were excluded.
An intensivist cannulated 95 patients (67%) while a cardiothoracic surgeon cannulated the remaining 47 patients (33%). Most of the patients were cannulated peripherally (91.5%) while 8.5% were cannulated centrally. There were 73 (51.4%) patients that were placed on VA ECMO in the operating room (OR) and the other 69 (49.6%) patients were cannulated in the intensive care unit (ICU).
The majority of patients were male (66.2%) with a median age of 63 (IQR=58-69) years. Half of the patients (50.7%) underwent coronary artery bypass graft (CABG), followed by CABG + valve (17.6%) and valve surgery only (15.5%). Most of the patients were placed on ECMO on the day of the surgery, median 0 (IQR 0-2) days and 28% were transitioned to ECMO from cardiopulmonary bypass (CPB). The median SOFA score at the time of ECMO initiation was 13 (IQR=11-15) and the median lactic acid was 6.6 (IQR=3-11) mmol/L. There were 91 (64%) patients that required 3 or more vasopressors/inotropes at the time of ECMO cannulation and 53.5% had another type of MCS prior to ECMO.
The median duration of VA ECMO support was 7 (IQR=3-13) days and the median hospital length of stay was 18 (IQR=8-31.7) days. Overall, 82 (57.7%) patients were successfully weaned from ECMO and 68 (47.9%) patients survived to discharge. The mortality on ECMO was 42.2% and post weaning mortality was 9.9%.

Conclusions: In our study of PCCS patients that required VA ECMO support, we show that an intensivist-led ECMO program can achieve good outcomes in this unique post-surgical patient population.