Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery: Outcomes and Challenges

Background

Outcomes of postcardiotomy extracorporeal membrane oxygenation (ECMO) are well studied, but preoperative ECMO bridging is less studied. This single-center review evaluates outcomes of patients supported with ECMO as a bridge to definitive cardiac surgery.

Methods

We retrospectively reviewed all patients who underwent ECMO as a bridge to cardiac surgery between 2013 and 2024. Patients decannulated before surgery or bridged to advanced heart failure therapies were excluded. The primary outcome was survival to hospital discharge. Secondary outcomes included survival to ECMO decannulation, total ECMO duration, and postoperative complications such as hemodialysis, tracheostomy, stroke, reoperation, and survival at 30 days and 1 year.

Results

Sixteen patients were analyzed, of whom 15 (94%) were cannulated for acute heart failure, 1 (6%) for respiratory failure, and 2 (13%) as an adjunct to cardiopulmonary resuscitation. The cohort was 56% female, with a median age of 59.5 years (interquartile range [IQR], 49.3-65.8 years). Surgical procedures included valve surgery (63%), ventricular septal defect repair (31%), and coronary artery bypass grafting (6%). The median ECMO duration was 7 days [IQR, 4-10.5 days]. Survival to decannulation occurred in 81.3%, and 50% survived through hospital discharge. Survivors had lower rates of postoperative dialysis (37.5% vs 87.5%; P = .04) but a longer length of stay (25 days vs 9.5 days; P = .01).

Conclusions

Preoperative ECMO as a bridge to cardiac surgery is a viable strategy for select high-risk patients, with acceptable survival rates. Larger multicenter studies are needed to refine patient selection and optimize management strategies.