Off-Hours versus Regular-Hours Implantation of Peripheral Venoarterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock

Abstract

Background. The “weekend effect” has been associated with worse clinical outcomes. Our aim was to compare off-hours vs. regular-hours peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock patients. Methods. We analyzed in-hospital and 90-day mortality among 147 consecutive patients treated with percutaneous VA-ECMO for medical reasons between July 1, 2013, and September 30, 2022, during regular-hours (weekdays 8:00 a.m.–10:00 p.m.) and off-hours (weekdays 10:01 p.m.–7:59 a.m., weekends, and holidays). Results. The median patient age was 56 years (interquartile range [IQR] 49–64 years) and 112 (72.6%) were men. The median lactate level was 9.6 mmol/L (IQR 6.2–14.8 mmol/L) and 136 patients (92.5%) had a Society for Cardiovascular Angiography and Interventions (SCAI) stage D or E. Cannulation was performed off-hours in 67 patients (45.6%). In-hospital mortality was similar in off-hours and regular hours (55.2% vs. 56.3%, p = 0.901), as was the 90-day mortality (58.2% vs. 57.5%, p = 0.963), length of hospital stay (31 days [IQR 16–65.8 days] vs. 32 days [IQR 18–63 days], p = 0.979), and VA-ECMO related complications (77.6% vs. 70.0%, p = 0.305). Conclusions. Off-hours and regular-hours percutaneous VA-ECMO implantation in cardiogenic shock of medical cause have similar results. Our results support well-designed 24/7 VA-ECMO implantation programs for cardiogenic shock patients.