Prognostic implications of complications during VA-ECMO for cardiogenic shock

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ID: 331421
2026
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Abstract
PURPOSE: Veno-arterial extracorporeal oxygenation (VA-ECMO) provides comprehensive cardiopulmonary support in patients with cardiogenic shock (CS), but may result in complications. While complications rates are known, their impact on risk of death remains largely unknown. METHODS: Using the Extracorporeal Life Support Organization (ELSO) Registry to identify adults with a diagnosis of CS treated with VA-ECMO (2017-2024), we analyzed the association between timing and type of complication and in-hospital mortality using three methodologies: 1) Cox proportional hazards analysis, treating complications as time-dependent covariates; 2) Multi-State Model (MSM) analysis, treating complications as transient states and estimating the differential mortality rate from each of these states; and 3) landmark Kaplan Meier survival analysis, estimating conditional survival curves, given survival to 3 weeks, based on count and timing of complications. RESULTS: Among 22,547 patients (31.7% female), 12,094 (54%) died during index hospitalization. More non-survivors experienced complications than survivors (74% vs 54%), with all sub-types occurring more frequently. Neurologic complications increased the hazard of mortality by 3.6 (95% C.I 3.4 - 3.8). MSM analysis indicated that the absolute 30-day risk of mortality was greater if a patient had a complication, increasing from 48.6% (0 complications) to 93.1% with a neurologic complication. Landmark survival analysis demonstrated that patients without complications within the first 3 weeks had the highest conditional survival. CONCLUSION: Complications on VA-ECMO have a significant and cumulative effect on in-hospital mortality, with a higher number associated with increased risk of death. Neurologic and pulmonary complications were associated with the greatest mortality risk.
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Authors Aniket S. Rali, Dhruv Sarma, Hui Li, Martin Urner, Philip S. Boonstra, Peta M. A. Alexander, Ryan P. Barbaro, Carlos L. Alviar, Jacob Colin Jentzer, Edward Wilson Grandin, Matthew D. Bacchetta, Brian Lima, Zubair I. Shah, Peter T. Rycus, Joseph E. Tonna
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Journal European Heart Journal Acute Cardiovascular Care
Year 2026
DOI
10.1093/ehjacc/zuag127
URL
https://doi.org/10.1093/ehjacc/zuag127
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