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While complication rates are known, their impact on the risk of death and on the risk of development of further complications remains largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Using the Extracorporeal Life Support Organization Registry to identify adults with a diagnosis of CS treated with VA-ECMO (2017\u201324), we analysed the association between timing and type of complication and in-hospital mortality using three methodologies: (i) Cox proportional hazards analysis, treating complications as time-dependent covariates; (ii) Multi-State Model (MSM) analysis, treating complications as transient states and estimating the differential mortality rate from each of these states; and (iii) landmark Kaplan\u2013Meier survival analysis, estimating conditional survival curves, given survival to 3 weeks, based on count and timing of complications. Among 22 547 patients (31.7% female), 12 094 (54%) died during index hospitalization. More non-survivors experienced complications than survivors (74% vs. 54%), with all subtypes occurring more frequently. Neurologic complications increased the hazard of mortality by 3.6 (95% CI 3.4\u20133.8). The MSM analysis indicated that the absolute 30-day risk of mortality was greater if a patient had a complication, increasing from 48.6% (0 complications) to 93.1% with a neurologic complication. Landmark survival analysis demonstrated that patients without complications within the first 3 weeks had the highest conditional survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Complications on VA-ECMO have a significant and cumulative effect on in-hospital mortality, with a higher number associated with increased risk of death. Neurologic and pulmonary complications were associated with the greatest mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Take Home message<\/jats:title>\n                    <jats:p>Complications on VA-ECMO support have a significant and cumulative effect on in-hospital mortality, with a higher number of complications associated with increased risk of death. Each complication increases the risk of transition to another complication or to death. Neurologic and pulmonary complications were associated with the greatest risk of death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag127","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:31:52Z","timestamp":1791286312000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic implications of complications during veno-arterial extracorporeal membrane oxygenation for cardiogenic shock"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3778-9979","authenticated-orcid":false,"given":"Aniket S","family":"Rali","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases, Vanderbilt University Medical Center , Nashville, TN ,","place":["USA"]},{"name":"Division of Critical Care Medicine, Vanderbilt University Medical Center , Nashville, TN 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