This retrospective single-centre study included 186 adults extubated during ongoing VA-ECMO after cardiac surgery. Unplanned reintubation within seven days occurred in 44 patients (23.6%), mainly because of acute respiratory failure or neurological impairment. Extubation failure was associated with fewer ventilator-free days, longer ICU stay, and higher short- and long-term mortality. Renal replacement therapy during ICU stay was independently associated with failure (adjusted odds ratio 3.209, 95% confidence interval 1.418–7.467); older age and massive intraoperative transfusion were also associated with failure, while effective post-extubation cough was associated with success.
Extubation failure was common in this postoperative VA-ECMO cohort and associated with adverse outcomes. These findings identify potential risk markers, rather than establish criteria for extubation decisions.
Study limitation: The retrospective, single-centre design limits generalisability and cannot establish whether extubation failure caused the associated adverse outcomes.
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