Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older

Abstract BACKGROUND: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in the elderly with cardiopulmonary failure after cardiac surgery. METHODS: This is a retrospective multicenter study on 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review and meta-analysis of the literature was performed. RESULTS: The hospital mortality in the overall PC-ECMO series was 64.4%. Two-hundred and fifty-five patients were ≥70 years old (32.7%) and their hospital mortality was significantly higher than younger patients (76.1% vs. 58.7%, adjusted OR 2.199, 95%CI 1.536-3.149). Arterial lactate >6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients ≥70 years old in univariate analysis (82.6% vs. 70.4%, p=0.029). Meta-analysis of the current and prior studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged ≥70 years compared with younger patients (OR 2.09, 95%CI 1.59-2.75, five studies including 1547 patients, I2 5.9%). The pooled early mortality rate among patients aged ≥70 years was 78.8% (95%CI 74.1-83.5, six studies including 617 patients, I2 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients ≥70 years old. CONCLUSIONS: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, a meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in the elderly.