Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation for Post-Cardiotomy Acute Respiratory Distress Syndrome

PURPOSE: Acute lung injury after cardiac surgery portends mortality rates as high as 40-80%. Very limited data are available regarding the utilization of venovenous extracorporeal membrane oxygenation (VV-ECMO) in patients with severe post-cardiotomy acute respiratory distress syndrome (PC-ARDS). METHODS: A retrospective review of consecutive patients with PC-ARDS managed with VV-ECMO from 2014-2020 at a single institution was performed. Data were collected from the institutional ELSO registry and supplemented with chart review. Survival to key time-points was assessed. RESULTS: A total of 22 patients (mean age 60±15 years, 73% male) with PC-ARDS were managed with VV-ECMO during the study period. Their mean Respiratory ECMO Survival Prediction (RESP) score was -5.9±3.5. ECMO support was initiated in 11/22 (50%) patients within 24h of the index operation, and between 2-23 days postoperatively (median 4 days) in the remaining patients. VV-ECMO was the initial cannulation strategy in 16/22 (73%) cases. In the remaining 6/22 (27%) cases, VA-ECMO was initiated and then transitioned to VV-ECMO after median 3 days (range 0.5-13 days). Survival to decannulation and to discharge occurred in 15/22 (68%) and 8/21 (38%) patients, respectively. One patient is still admitted to the hospital and has been decannulated from VV-ECMO. After median follow-up 545 days (range 11-1306 days) among survivors to hospital discharge, 60-day and 1-year survival were 86% and 67%, respectively. Patients surviving to hospital discharge were younger than non-survivors (mean age 50±15 versus 65±13 years, p=0.03), but there was no difference in RESP score among these groups (survivors: -5.8±2.8 versus non-survivors: -6.0±4.8, p=0.90). CONCLUSION: Although post cardiotomy ARDS is associated with a high mortality, VV-ECMO should be considered as a potential rescue strategy, especially in younger patients.