An ELSO Registry analysis included 22,547 adults receiving VA-ECMO for cardiogenic shock during 2017–2024; 54% died in hospital. Complications occurred in 74% of nonsurvivors versus 54% of survivors. Neurologic complications were associated with a mortality hazard ratio of 3.6 (95% confidence interval 3.4–3.8). Multistate analysis estimated 30-day mortality risk at 48.6% without complications and 93.1% with a neurologic complication. Among patients surviving to three weeks, those without complications during that period had the highest conditional survival. Neurologic and pulmonary complications were associated with the greatest mortality risk.
Complication type and timing were associated with mortality during VA-ECMO for cardiogenic shock. These findings provide prognostic context but do not establish that complications caused the observed excess mortality.
Study limitation: Observational registry associations cannot establish causality; the three-week landmark findings apply only to patients surviving to that point.
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