Venopulmonary extracorporeal life support: An Extracorporeal Life Support Organization registry analysis

Background There is a paucity of data informing on the current use, adverse events, outcomes, and prognostic drivers for patients receiving venopulmonary extracorporeal life support (VP ECLS). We aimed to provide a contemporary, large sample size study to describe the real-world outcomes of adults supported with VP ECLS across different clinical conditions. Methods We queried the Extracorporeal Life Support Organization Registry to retrieve all adult patients who received VP ECLS as the first support modality from July 2020 to July 2024. Study population was grouped according to hospital death outcome and to the diagnosis leading to VP ECLS use. Adverse outcomes are reported according to the diagnosis leading to VP ECLS use. A time-to-event Cox regression model was applied to identify predictors of death. Results A total of 838 patients [32.3% females; age 8 (46, 67) years] were included. Patients were treated for heart failure/cardiogenic shock (HF/CS) in 54.4%, for acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS) in 26.6%, for post-cardiotomy shock in 6.7%, for acute coronary syndrome/ischemic heart disease in 5.3%, for valvular heart disease/complications of intracardiac devices in 4.2%, and for pulmonary embolism in 2.9%. Most common adverse events included continuous renal replacement therapy (CRRT) use or acute kidney injury (37.4%), infections (35.4%), cardiac arrhythmias (13.5%), surgical site bleeding (12.1%), gastrointestinal (GI) bleeding (6.1%). Complications were more common in non-survivors and patterns of complications differed among diagnosis groups. The Kaplan-Meier estimated 60-day survival was 49.3 (45.3, 53.1)%. Age (HR<inf>adj</inf> 1.15 for 5 years increase; 95%CI 1.11, 1.20; p ' 0.001), female sex (HR<inf>adj</inf> 1.40; 95%CI 1.12, 1.76; p = 0.003), body mass index (HR<inf>adj</inf> 1.02 for 3 kg/m² increase; 95%CI 1.01, 1.04; p ' 0.018), CRRT use prior VP ECLS cannulation (HR<inf>adj</inf> 1.44; 95%CI 1.11, 1.86; p ' 0.006) were independent predictors of death. Conclusions In this large Extracorporeal Life Support Organization registry analysis, VP ECLS was chiefly used for HF/CS and ARF/ARDS. Hospital outcomes, complications, and survival differed according to the diagnosis leading to VP ECLS use. Younger age, male sex, lower BMI, and no CRRT use prior to VP ECLS cannulation confer a lower risk of death and provide targets for future research and potential domains for clinical improvement.