Background: Post-cardiotomy cardiogenic shock (PCCS) is a life-threatening complication with high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides essential circulatory support for these patients. This study aimed to quantify the cumulative burden of major systemic complications and evaluate its predictive value for in-hospital mortality. Methods: Using the Chinese Society of Extracorporeal Life Support (CSECLS) multicenter database, we retrospectively analyzed 899 adult patients who received VA-ECMO following cardiac surgery. A complication burden score (0–4) was developed based on the involvement of four core systems: vascular (limb ischemia/injury), renal (AKI requiring CRRT), coagulation (major hemorrhage), and neurological (stroke/encephalopathy). The cohort was stratified into four groups: burden score 0 (n=239), score 1 (n=375), score 2 (n=204), and score ≥3 (n=81). Results: The overall incidence of complications was high, with CRRT (52.8%), hemorrhage (27.1%), vascular complications (23.1%), and neurological events (12.3%) being most prevalent. In-hospital mortality exhibited a significant “step-ladder” increase corresponding to the cumulative burden score: 41.8% for score 0, 56.0% for score 1, 70.1% for score 2, and 79.0% for score ≥3 (P trend < 0.001). After adjusting for age, pre-ECMO lactate, and SCAI shock stage, the complication burden score remained a strong independent predictor of death (OR = 1.63 per 1-point increase; 95% CI: 1.40–1.91, P < 0.001). Compared to patients with no complications, the risk of death increased significantly in those with score 2 (OR = 3.22) and reached a 6.59-fold increase in those with score ≥3 (95% CI: 3.11–13.97, P < 0.001). Conclusions: The prognosis of post-cardiotomy ECMO patients is decisively influenced by the cumulative effect of systemic complications. Each additional system involved independently increases the risk of mortality by 63%.
Li et al. (Mon,) studied this question.