Survival Predictors and Clinical Outcomes in Patients Undergoing Venoarterial ECMO: A 7‐Year Retrospective Study

Purpose: Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving intervention for refractory cardiopulmonary failure. Identifying factors associated with survival is essential for optimizing patient selection and management. In this study, we aimed to identify VA‐ECMO survival predictors and evaluate the associated complications, costs, and outcomes. Methods: A retrospective analysis was conducted on data from 123 adult patients who underwent VA‐ECMO at the Songklanagarind Hospital between 2017 and 2023. Clinical characteristics, ECMO‐related complications, hospital expenses, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were used to determine independent predictors of survival. Results: Fifty (40.7%) patients survived until hospital discharge. Compared to central VA‐ECMO, peripheral VA‐ECMO was significantly associated with improved survival (adjusted OR: 26.44, 95% CI: 1.95–358.7, p = 0.014). Preexisting liver dysfunction (adjusted OR: 0.27, 95% CI: 0.09–0.79, p = 0.016) and renal dysfunction (adjusted OR: 0.29, 95% CI: 0.1–0.85, p = 0.023) were independent mortality predictors. Survival odds were significantly lower in patients with American Society of Anesthesiologists (ASA) Class 5 (adjusted OR: 0.07, 95% CI: 0.01–0.67, p = 0.022). Neurological complications were more common in nonsurvivors than in survivors (41.1% vs. 18%, p = 0.012). Survivors had significantly higher total hospital costs (997,563.5 vs. 696,191 THB, p = 0.004) and longer hospital stays (28.5 vs. 3 days, p < 0.001). The multivariate model demonstrated strong predictive performance, with an area under the curve of 0.85. Conclusions: ECMO cannulation strategy, preexisting liver and renal dysfunction, and ASA classification were key factors associated with survival. Peripheral VA‐ECMO was associated with better outcomes, and organ dysfunction significantly increased the mortality risk.