Outcomes in Patients Requiring VENO-Venous Extracorporeal Membrane Oxygenation After Cardiac Surgery: An Analysis From the PELS-1 Study

Background: Acute respiratory failure after cardiac surgery is an uncommon complication, affecting morbidity and mortality. In these patients, respiratory extracorporeal membrane oxygenation (ECMO) support may be beneficial, as it may help reduce pulmonary vasoconstriction and the impact of respiratory pressures on the heart. Nevertheless, literature reports of postcardiotomy veno-venous (V-V) ECMO use are sporadic. Methods: This retrospective, multicenter cohort study analyzes data from the PELS-1 registry, focusing on adult patients who required V-V ECMO following cardiac surgery. PELS-1 was conducted across 34 cardiac surgery centers in 16 countries from 2000 to 2020. Results: The study included 24 patients who received V-V ECMO over a total of 2163 patients requiring postocardiotomy extracorporeal support (1.1%). The median age was 64[50–69] years, and 16/24 (67%) were male. Median Euroscore II was 6.2[3.1–19.6]. Most patients required prolonged cardiopulmonary bypass (CPB) time (208[110–350] min). V-V ECMO was initiated in the ICU in 21 patients (87.5%) after a median of 5 [2–12] days postoperatively. ECMO support rapidly normalized gas exchange and lactate levels. However, complications were frequent: bleeding (10/22, 45.5%), acute kidney injury (10/24, 41.7%), pneumonia (10/24, 41.7%), and arrhythmias (7/24, 29.2%) were the most frequent ones. In-hospital mortality was high, with only 21.7% discharged alive. One-year survival was 12.5%. Conclusions: Reported outcomes of patients receiving V-V ECMO after cardiac surgery are poor, despite effective correction of gas exchange. Early recognition of isolated respiratory failure and careful patient selection should be promoted. Further research is needed to optimize management in this high-risk population.