Application of awake veno-arterial extracorporeal membrane oxygenation in post-cardiac surgery:a single center retrospective cohort study

Luo Jianchao; Zhai Mengen; Lu Linhe; Lyu Xiangni; Liu Jincheng; Liu Yang

doi:10.13498/j.cnki.chin.j.ecc.2025.04.03

Abstract：Objective To investigate the optimal timing,prognostic benefits and influencing factors of awake extracorporeal membrane oxygenation(ECMO)in patients following cardiac surgery.Methods The clinical data of 56 patients with"awake ECMO"after cardiac surgery from January 2022 to June 2024 in Xijing Hospital were retrospectively analyzed.Patients were categorized into a fully awake group(no mechanical ventilation during ECMO)and a non-fully awake group(mechanical ventilation required during ECMO).The non-fully awake group was further stratified into an early awake subgroup(mechanical ventilation duration<40%of total ECMO support time)and a non-early awake subgroup(mechanical ventilation duration≥40%).The baseline data,extubation factors and clinical outcomes were compared between groups.Multivariate analysis was performed to identify predictors of early tracheal extubation in the non-fully awake group.Results The fully awake group exhibited significantly higher hospital survival rates compared to the non-fully awake group(P=0.04).The fully awake group also demonstrated shorter total mechanical ventilation time,reduced ICU stays,shorter hospitalization,and lower rates of major complications In the non-fully awake group,the early awake subgroup achieved higher survival rates and lower complication rates(P<0.001).Albumin and prealbumin significantly improved during awake ECMO compared to tracheal intubation(P<0.05).Multivariate analysis identified postoperative pulmonary complications and oxygenation index as independent predictors of successful awake ECMO implementation.Conclusion Early awake V-A ECMO in post-cardiac surgery patients is associated with improved survival,reduced complications,enhanced nutritional status,and shorter hospital stays.