Clinical-experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: Survival at five years

Objectives: We sought to determine 5-year survival after extracorporeal mem brane oxygenation for cardiac failure and its predictors, to assess surviva l and its predictors after bridging to transplantation or weaning from extr acorporeal membrane oxygenation, and to identify factors influencing the li kelihood of these outcomes. Methods: Two hundred two adults (mean age, 55 +/- 14 years) were supported with extracorporeal membrane oxygenation between 1992 and July 1999 after c ardiac failure. Follow-up extended to 7.5 years (mean, 3.8 +/- 2 years). Mu ltivariable hat ard function analysis identified predictors of survival, an d logistic regression identified the determinants of bridging or weaning. Results: Survival at 3 days, 30 days, and 5 years was 76%, 38%, and 24%, re spective ly. Patients surviving 30 days had a 63% 5-year survival. Risk fac tors (P < .1) included older age, reoperation, and thoracic aorta repair. F orty-eight patients were bridged to transplantation, and 71 were weaned wit h intent for survival. Survival was similar after either outcome (44% VS 40 % 5-year survival, respectively). Failure to bridge or wean included (P < . 03) renal and hepatic failure on extracorporeal membrane oxy genator suppor t, occurrence of a neurologic event, and absence of infection. The dominant modes of death were cardiac failure and multisystem organ failure. Conclusions: Extracorporeal membrane oxygenation is versatile and salvages some patients who would otherwise die. Improvement in intermediate-term out come will require a multidisciplinary approach to protect organ function an d limit organ injury before and during this: support.