Timing of VA-ECMO Support During or After Cardiac Surgery

Some patients develop severe heart failure during or after cardiac surgery and require temporary support for circulation and oxygenation. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a form of life support that circulates blood outside the body through a pump and an oxygenator while the heart recovers. This retrospective study examines 128 adults who received VA-ECMO for postcardiotomy cardiogenic shock at the National Institute for Cardiovascular Diseases in Bratislava, Slovakia, between January 2013 and June 2026. The study includes 78 patients who started support during the operation or because they could not be separated from cardiopulmonary bypass, and 50 patients who started support later in the intensive care unit after postoperative deterioration. The main objective is to evaluate the association between the timing of VA-ECMO initiation and death before hospital discharge. Additional outcomes include successful removal of ECMO with survival for at least 24 hours after decannulation, duration of ECMO support, and length of hospitalization. Existing clinical records are used to account for measured differences in patient condition and surgical complexity. All treatment decisions were made by the treating clinical team during routine care.

Inclusion Criteria: * Age 18 years or older * Cardiac surgery at the study center * Postcardiotomy cardiogenic shock requiring VA-ECMO during the operation or after surgery * Initiation of support between January 2013 and June 2026 Exclusion Criteria: * Age younger than 18 years * ECMO initiated for an indication unrelated to postcardiotomy cardiogenic shock * Exclusively venovenous ECMO without an arterial circulatory support component