Patients and data collection
Since the beginning of the ECMO program at our institution in 2005, all
data regarding patients receiving veno-arterial support for hemodynamic
failure have been prospectively entered in an electronic database
registry by dedicated research nurses. This database is regularly
checked for completeness and consistency. In December 2020, we performed
a retrospective analysis of patients included in the registry (n = 951)
over the January 2005 to December 2020 period. The indication for
VA-ECMO therapy was established in compliance with the current
recommendations(2) by a multidisciplinary team including two
intensivists and a heart surgeon in all cases. The indication was
decided when the chances of success were believed to outweigh the risks
and the use of hospital resources. Patients had to present an expected
good quality of life and either potential for recovery or possible
candidacy to transplantation or long-term mechanical support. When
VA-ECMO was judged to prolong the course of illness without a realistic
chance of survival or acceptable quality of life in case of recovery,
ECMO support was not instituted. VA-ECMO was implanted for refractory
circulatory failure with isolated one-organ insufficiency or before
severe multiorgan failure developed. Patients were evaluated using the
Simplified Acute Physiology Score (SAPS) version 2 immediately before
VA-ECMO cannulation [5], using the calculator available online at
www.sfar.org (French Society of Anesthesia and Intensive Care website).
All patients receiving VA-ECMO at our institution were included in the
present study.