Nighttime/Weekend Venoarterial Extracorporeal Membrane Oxygenation Cannulation Is Not Associated With Increased 1-year Mortality for Non-ECPR Indications

Abstract

ObjectivesThe process of placing a patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) is complex and requires the activation and coordination of numerous personnel from a variety of disciplines to achieve procedural success, initiate flow, and subsequently monitor the patient's condition. Existing literature suggests that nighttime cannulation for extracorporeal cardiopulmonary resuscitation (eCPR) is associated with adverse outcomes compared to daytime cannulation. Given the strain on personnel that this process can create, it is plausible that patients who are initiated on VA-ECMO for non-eCPR indications during the nighttime and on weekends, which are generally periods with reduced staffing as compared to weekday daytime hours, may also experience worse outcomes including decreased survival. Our objective was to determine whether nighttime/weekend VA-ECMO cannulations were associated with worse outcomes including decreased survival. Designretrospective cohort study SettingLarge quaternary academic medical center Participantspatients InterventionsVA-ECMO cannulation during the day versus night/weekends MeasurementsWe performed a retrospective review of patients at a single center who underwent VA-ECMO cannulation between 2011-2021. There were 468 patients included: 158 (33.8%) patients in the daytime cannulation cohort and 310 (66.2%) in the nighttime/weekend cannulation cohort. Nighttime and weekend VA-ECMO cannulations were not associated with increased 1-year mortality (64.2% vs 60.1%, P=0.42) or renal replacement therapy (25.4% vs 22.2%, P=0.49). ConclusionsWe conclude nighttime and weekend VA-ECMO cannulations can be performed safely at a large academic medical center.