Background

This study aimed to evaluate in-hospital mortality and to identify predictors of mortality in coronary artery bypass grafting (CABG) patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support.

Methods and results

We retrospectively analysed data from adult patients who received VA-ECMO for cardiogenic shock after CABG at our centre between 2014 and 2025. Among the 10,256 patients who underwent CABG, 74 received ECMO postoperatively. Among these, 33 patients (44.6%) died during ECMO support, 15 patients (20.3%) died after ECMO removal, and 26 patients (35.1%) survived to hospital discharge. For distinguishing hospital mortality, the lactate level at 24 h after ECMO initiation (LAC-T24) (> 4.35 mmol/L, AUROC: 0.916) performed the best, followed by the lactate clearance at 24 h (LC-T24) (< 55.73%, AUROC: 0.915). Other predictive factors included CKMB activity at 24 h (CKMB-T24) (> 157 U/L; AUROC: 0.848), mean arterial pressure at 24 h (MAP-T24) (< 77.5 mmHg; AUROC: 0.844), SOFA-2 scores (> 11.5; AUROC: 0.835), and the pre-ECMO Sequential Organ Failure Assessment scores (SOFA-1) (> 10.5; AUROC: 0.815). The best model revealed the pre-ECMO updated SOFA-2 scores (P < 0.001) (OR: 1.793, 95% CI: 1.029–3.124, P = 0.039), LAC-T24 (OR: 1.395, 95% CI: 1.045–1.861, P = 0.024), CKMB-T24 (OR: 1.015, 95% CI: 1.003–1.026, P = 0.013), and MAP-T24 (OR: 0.895, 95% CI: 0.809–0.989, P = 0.029) as independent predictors of hospital mortality after VA-ECMO.

Conclusion

In patients receiving ECMO treatment after CABG, in-hospital mortality rates remains high. In this study, LAC-T24, LC-T24, CKMB-T24, pre-ECMO SOFA-1 and SOFA-2 scores were identified as predictors of mortality.