Late Breaking Abstract - Long-term outcome of perioperative extracorporeal membrane oxygenation (ECMO) in patients undergoing pulmonary endarterectomy (PEA)

Abstract

Introduction: ECMO is a recognised technique used by many centres to support the most challenging PEA patients in the perioperative period. The aim of our study was to assess short and long-term outcomes in PEA patients supported with ECMO.

Methods: We retrospectively analysed ECMO use in 1114 consecutive patients undergoing PEA between 2007 and 2016 in a single centre. Outcomes, including survival, exercise capacity (6MWD), morbidity and quality of life (QoL–Camphor questionnaire) were compared between patients supported with ECMO and those who did not require ECMO.

Results: Out of 1114 patients 61(5.3%) required perioperative ECMO support. Thirty (49%) patients who received ECMO survived to ICU discharge and 28 (46%) were alive at 90 days. Mortality at one year after surgery was higher in patients requiring ECMO support (10.7% vs 1.9%, p=0.001) but there were no further deaths in ECMO group beyond one year. Follow-up at 3 and 12 months post discharge showed no differences in 6MWD, symptoms and activity scores between survivors supported with ECMO or not. However, QoL at 3 and 6 months was significantly lower in patients who had been supported with ECMO (median, IQR 4[0-10] vs 9[1.8-12.3], p=0.04; 2[0-8] vs 8[2-16], p=0.02). Long-term morbidity from ECMO related complications was reported in 5 survivors and included neurological sequel and/or ischemia to hands and feet.

Conclusions: Perioperative ECMO was used in 5.3% of PEA patients with 49% of those patients surviving to ICU discharge. After the first year, long term survival was similar between patients who had or not been supported with ECMO.