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.