Nighttime/Weekend Venoarterial Extracorporeal Membrane Oxygenation Cannulation Is Not Associated With Increased 1-Year Mortality for Non-Extracorporeal Cardiopulmonary Resuscitation Indications.

Background: The process of placing a patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) is complex and requires the activation and coordination of numerous personnel from a variety of disciplines to achieve procedural success, initiate flow, and subsequently monitor the patient's condition. The literature suggests that nighttime cannulation for extracorporeal cardiopulmonary resuscitation (ECPR) is associated with adverse outcomes compared to daytime cannulation. Given the strain on personnel that this process can create, it is plausible that patients who are initiated on VA-ECMO for non-ECPR indications during the nighttime and on weekends, which are generally periods with reduced staffing compared to weekday daytime hours, also may experience worse outcomes, including decreased survival. This study aimed to determine whether nighttime/weekend VA-ECMO cannulation is associated with worse outcomes, including decreased survival.

Design: Retrospective cohort study SETTING: Large quaternary academic medical center PARTICIPANTS: Patients INTERVENTIONS: VA-ECMO cannulation during the day versus night/weekends MEASUREMENTS: We performed a retrospective review of patients at a single center who underwent VA-ECMO cannulation between 2011 and 2021. The 468 patients included 158 patients (33.8%) in the daytime cannulation cohort and 310 (66.2%) in the nighttime/weekend cannulation cohort. Nighttime and weekend VA-ECMO cannulations were not associated with increased 1-year mortality (64.2% vs 60.1%; p = 0.42) or with increased use of renal replacement therapy (25.4% vs 22.2%; p = 0.49).

Conclusions: We conclude that nighttime and weekend VA-ECMO cannulations can be performed safely at a large academic medical center.