In-Hospital Versus outside Hospital Cannulation for Venoarterial Extracorporeal Membrane Oxygenation

Background: Postcardiotomy shock (PCS) is a rare but serious complication after cardiac surgery and may be treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).Frequently, patients with PCS are transferred from outside hospitals (OSH) to tertiary centers for further care.We sought to investigate whether mortality differed between OSH versus inhospital cannulation at the tertiary center (INH).Methods: We retrospectively studied patients treated with VA-ECMO for PCS at our institution between January 2017 through June 2022.We compared the two cohorts based on where cannulation occurred: INH and OSH.Primary outcome was 30-day mortality.Multivariate logistic regression models were used to identify risk factors for 30-day mortality.Results: A total of 105 patients with PCS were treated with VA-ECMO at our center (52% INH cannulation and 48% OSH cannulation).Sixty-eight percent (71/105) were centrally cannulated and 32% (34/105) peripherally cannulated.Overall, 30-day mortality was 59% (62/105).There was no statistical difference between patients cannulated at OSH versus INH with regards to 30-day mortality (66% vs 53%, p=0.167), survival to decannulation (52% vs 62%, p=0.310), or survival to discharge (34% vs 47%, p=0.167).Multivariate analysis identified age, BMI, and post-operative dialysis as risk factors for 30-day mortality.Conclusion: There was no difference in 30-day mortality among patients cannulated INH versus OSH.Risk factors for 30-day mortality include older age, higher BMI, and postoperative dialysis.These data support the idea that critically ill patients with PCS should be placed on additional circulatory support and transferred to a tertiary center as soon as possible.