Clinical and Functional Outcomes Following Repeat VA-ECMO in Adults: A Propensity Score–Matched Comparative Study

Q: What are the key findings of this study?

Repeat VA-ECMO in adults was not associated with a significant difference in in-hospital mortality compared to a single run (OR 1.01), but was linked to prolonged support and higher multiorgan failure risk.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Refractory cardiac and/or respiratory failure (n=1496). Intervention: Repeat VA-ECMO vs. Single VA-ECMO run. Primary outcome: In-hospital mortality (OR 1.01, 95% CI 0.48-2.11, p=0.984).

Q: What does this research mean for the field?

Repeat VA-ECMO in adults shows no significant difference in in-hospital mortality compared to a single run, but is associated with prolonged support, increased transfusion requirements, and a higher risk of multiorgan failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kostiantyn Kozakov; Alois Philipp; Maik Foltan; Henrik Heuer; Walter Petermichl; Alexander Dietl; Bernhard Flörchinger; Leopold Rupprecht; Simon Schopka; Çhristof Schmid; Zdeněk Provazník

doi:10.3390/jcm15176627

August 27, 2026Journal of Clinical MedicineOpen Access

Clinical and Functional Outcomes Following Repeat VA-ECMO in Adults: A Propensity Score–Matched Comparative Study

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Key result

Repeat VA-ECMO shows no in-hospital mortality difference over a single run, despite higher morbidity.

OR 1.01
95% CI 0.48-2.11
P=0.984
n=1,496

Figures

Why the study?

Evidence on clinical and post-discharge functional outcomes after repeat VA-ECMO in adults remains limited.

Does a second run of VA-ECMO improve survival and functional outcomes compared to a single run in adult patients with cardiocirculatory failure?

Key Points

To compare survival, post-discharge functional outcomes, and clinical complications between adult patients requiring a second VA-ECMO run and propensity score–matched patients supported with a single run.
Observational, single-center, retrospective cohort study conducted at a tertiary-care referral center between 2006 and 2024.
Included 1496 adult patients (≥18 years) treated with VA-ECMO, of whom 30 (2.0%) required a second run, alongside a 1:3 propensity score–matched cohort of 120 patients (90 single-run vs. 30 repeat VA-ECMO).
Survival outcomes did not differ significantly between cohorts for in-hospital mortality (OR 1.01; 95% CI, 0.48–2.11; p = 0.984), 30-day survival (OR 1.49; 95% CI, 0.72–3.07; p = 0.280), or overall survival (OR 1.27; 95% CI, 0.59–2.73; p = 0.272).
Repeat VA-ECMO required significantly longer support (median 6 vs. 4 days; p = 0.003) and higher red blood cell transfusion exposure (median 7.5 vs. 2 units; p < 0.001).

Study Design

Type

Cohort (n=1,496)

Multicenter

No

Structured PICO

Does a second run of VA-ECMO improve survival and functional outcomes compared to a single run in adult patients with cardiocirculatory failure?

P

Population

1,496 adult patients requiring VA-ECMO for refractory cardiocirculatory or respiratory failure, including 30 who required a second run, evaluated retrospectively.

E

Exposure

Second run of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiated after successful weaning and decannulation from a preceding ECMO course.

C

Comparator

Single run of veno-arterial extracorporeal membrane oxygenation (VA-ECMO), compared using 3:1 propensity score matching.

O

Outcome

In-hospital mortality, 30-day outcomes, overall survival, and functional status (assessed using the ECOG performance status in hospital survivors).hard clinical

Main Result

Odds Ratio: 1.01 (95% CI 0.48–2.11)

p-value: p=0.984

Repeat VA-ECMO in adults is feasible and yields similar survival to a single run, but is associated with prolonged support, higher transfusion needs, and an increased risk of multiorgan failure.

Limitations

Retrospective observational design limits causal inference and is prone to selection bias.
Absence of uniform protocols for ECMO weaning and repeat-run inclusion and initiation.
Relatively small number of patients undergoing repeat ECMO, with an inherent risk of type II error.
Inherent survivor selection bias that cannot be fully addressed by propensity score matching.
ECOG analysis was limited to hospital survivors with available follow-up data, introducing potential survivor and availability bias.
Retrospective observational design prone to selection bias
Long study period of 18 years with changes in ECMO technology and clinical management
Absence of uniform protocols for ECMO weaning and repeat-run initiation
Small number of repeat VA-ECMO patients with inherent risk of type II error
Survivor selection bias
ECOG analysis limited to hospital survivors with available follow-up data

Implication

May warrant caution with repeat VA-ECMO due to higher morbidity; leaves open optimal patient selection for prospective trials.

Abstract

Background/Objectives: Evidence on outcomes after repeat VA-ECMO in adults remains limited. This study aimed to compare survival and post-discharge functional outcomes between adults requiring a second VA-ECMO run and propensity-matched patients supported with a single VA-ECMO run and to characterize the clinical course during repeat support. Methods: This is an observational, single-center, retrospective cohort study with a propensity score–matched comparative analysis, conducted at a university tertiary-care referral center between 2006 and 2024. This study included 1496 adult patients (≥18 years) treated with VA-ECMO, of whom 30 (2.0%) required a second VA-ECMO run. Primary endpoints were in-hospital mortality, 30-day outcomes, and overall survival. Secondary exploratory analyses assessed baseline hemodynamic and metabolic parameters, multiorgan failure, neurological complications, and cannulation-related complications. Results: Repeat VA-ECMO was associated with longer support duration (median 6 vs. 4 days; p = 0.003) and a higher risk of MOF (OR 3.45; 95% CI 1.45–8.19; p = 0.003). No statistically significant differences in survival were observed (in-hospital mortality (OR 1.01; 95% CI, 0.48–2.11; p = 0.984); 30-day survival (OR 1.49; 95% CI, 0.72–3.07; p = 0.280); overall survival (OR 1.27; 95% CI, 0.59–2.73; p = 0.272). Repeat VA-ECMO was associated with higher transfusion requirements (RBC median 7.5 vs. 2 units; p < 0.001). After propensity matching, prolonged support, increased MOF, and higher transfusion burden persisted. ECOG outcomes were comparable overall; however, a borderline trend toward worse functional status was observed in patients undergoing repeat VA-ECMO during the same hospitalization (p = 0.057). Conclusions: Repeat VA-ECMO may be feasible in carefully selected adults, with no significant differences in survival, but is associated with prolonged support, increased transfusion requirements, and substantially higher MOF risk.

Discussion

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Cite This Study

Kozakov et al. (2026) conducted a cohort in Refractory cardiac and/or respiratory failure (n=1,496). Repeat VA-ECMO vs. Single VA-ECMO run was evaluated on In-hospital mortality (OR 1.01, 95% CI 0.48-2.11, p=0.984). Repeat VA-ECMO in adults was not associated with a significant difference in in-hospital mortality compared to a single run (OR 1.01), but was linked to prolonged support and higher multiorgan failure risk.

synapsesocial.com/papers/6a92be7b8e5d7d1fc0c12318 https://doi.org/10.3390/jcm15176627

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Clinical and Functional Outcomes Following Repeat VA-ECMO in Adults: A Propensity Score–Matched Comparative Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Clinical and Functional Outcomes Following Repeat VA-ECMO in Adults: A Propensity Score–Matched Comparative Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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