title: Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  This study was designed to examine the long-term survival of patients who survived to be weaned from venoarterial extracorporeal membrane oxygenation (VA ECMO) and to determine which factors present at initiation and during ECMO predict long-term survival. We further sought to develop the preliminary long-term outcome after VA ECMO score that would predict patient outcome and to assess its accuracy at various time points.
  
  
  METHODS
  We conducted a retrospective, observational cohort study of all patients with cardiogenic shock treated with VA ECMO at the Alfred Hospital, Australia, from January 2007 until February 2013. Overall, 125 patients underwent ECMO, and 104 patients were successfully weaned and formed the study population, with a median follow-up of 21 months (range, 0-84).
  
  
  RESULTS
  Survival rates of those weaned from ECMO at 3 months, 12 months, and 2 years were 87%, 79%, and 71%, respectively, corresponding to overall survival rates at 3 months of 90 (72%) of 124; at 12 months, 80 (65%) of 122; and 24 months, 57 (57%) of 100. Ischemic heart disease, higher lactate and higher bilirubin at initiation of VA ECMO, and a longer duration of renal replacement therapy during ECMO were all independently associated with decreased length of survival. Long-term survival was found to be highly related to the number of these risk factors present up to 2 years afterward.
  
  
  CONCLUSIONS
  Good long-term survival can be achieved in patients who have been successfully weaned from VA-ECMO. The factors present at initiation and during ECMO can relate to altered risk of long-term survival.
authors.affiliation: The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia; The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia. Electronic address: burrell@monash.edu.
authors.forename: Aidan J C
authors.initials: AJ
authors.lastname: Burrell
authors.affiliation: The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Pellegrino
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: The Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Wen Kai
authors.initials: WK
authors.lastname: Wong
authors.affiliation: The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia; The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: David Jamie
authors.initials: DJ
authors.lastname: Cooper
authors.affiliation: The Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Kaye
authors.affiliation: The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3004, VIC, Australia; The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: David V
authors.initials: DV
authors.lastname: Pilcher
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology
keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Heart failure; Long-term; Survival