How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis.

Summary

An individual patient data meta-analysis (n=1,267 across 25 centers) found the lowest in-hospital mortality with 3–6 days of VA-ECMO after cardiac surgery, and adjusted analyses showed no significant mortality increase with support beyond 6 days up to 20 days. These findings support not imposing arbitrary time limits and justify continued support when clinical trajectory is favorable.

Key Findings

• IPD meta-analysis of 1,267 postcardiotomy VA-ECMO patients from 10 studies and 25 hospitals.
• Lowest in-hospital mortality observed with 3–6 days of ECMO support.
• Adjusted multilevel mixed-effects modeling showed no significant increase in in-hospital mortality with ECMO duration >6 to 20 days.

Clinical Implications

Avoid fixed time limits for VA-ECMO cessation purely based on duration; decisions should integrate patient trajectory, recovery markers, and risk profiles. These data support continued support beyond 6 days when there is potential for recovery.

Limitations

• Retrospective source studies; residual confounding and selection biases remain possible.
• Analyses limited by variables known at ECMO initiation; evolving clinical course and decision factors may be unmeasured.

Future Directions

Prospective registries capturing time-varying physiology and decision rationales during ECMO; randomized or adaptive trials addressing weaning strategies and duration thresholds.