Mid Term Survival after VA ECMO Weaning

Purpose The aimed of this study was to evaluate the outcome of the patients successfully weaned from ECMO after cardiac recovery. Methods From January 2008 to January 2018, 384 patients were supported with VA ECMO for cardiogenic shock in our institution. 47.1% patients (n=181) died during support. 40.9% patients were weaned from VA-ECMO (n=157), 5.7% (n=22 were supported with a LVAD or a TAH and 6.3%patients (n=4) received a heart transplant. We prospectively followed the patients weaned from ECMO by periodic visit at our center. We analyzed survival, causes of early and late deaths and predictors for death for this population. Results 157 patients, median age 52 years (1 st and 3 rd quart. 39-62), were successfully weaned from VA ECMO after a median time of 7 days of support (1 st and 3 rd quart. 4-10 days). Main etiologies of shock were post cardiotomy (n=57, 36.3%), acute myocardial infarction (n=39, 24.8%), pulmonary embolism (n=11, 7.0%), myocarditis (n=6, 3.8%), and acute end stage heart failure (n=6, 3.8%). During a mean follow up of 1.9 years (max 10 years), 137 patients were discharged home. Early deaths ( 2 years from ECMO weaning) were due to septic shock (n=4), heart graft failure (n=1), unknown (n=1). Three patients underwent HTx, 2 others patients are still waiting for a HTx,. Overall one-month, 6- month and 3-years survival were respectively of 93.4 (IC: 87.7-96.5); 83.4% (IC: 75.3- 89.0) and 76.5% (IC: 65.1-84.6). By multivariate Cox analysis, ECMO duration (HR= 1.15, p=0.0002), stroke during ECMO course (HR =3.85, p=0.0015), age (HR=1.06, p=0.0008), and post cardiotomy shock (HR =3.62, p=0.0124) were independent risk factor for death. Conclusion In our ten-year experience, patients could be successfully weaned from ECMO after a refractory shock. Most of them had a satisfactory outcome and could be discharged home. Older age, a longer duration of support, stroke and post cardiotomy shock were associated with poor outcome. Further studies are needed to evaluate the risk of recurrence of heart failure and a close follow up of those patients is mandatory.