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Background  Extracorporeal membrane oxygenation (ECMO) represents a valuable and rapidly evolving therapeutic option in patients with severe heart or lung failure following cardiovascular surgery. However, despite significant advances in ECMO techniques and management, prognosis remains poor and accurate risk stratification challenging. We therefore evaluated the predictive value of liver function variables on all-cause mortality in patients undergoing venoarterial ECMO support after cardiovascular surgery.    Methods  We included into our single-center registry a total of 240 patients undergoing venoarterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center.    Results  The median follow-up was 37 months (interquartile range 19–67 months), and a total of 156 patients (65 %) died. Alkaline phosphatase and total bilirubin were the strongest predictors for 30-day mortality, with adjusted hazard ratios (HRs) per 1–standard deviation increase of 1.36 (95 % confidence interval [CI] 1.10–1.68;  P  = 0.004) and 1.22 (95 % CI 1.07–1.40;  P  = 0.004), respectively. The observed associations persisted for long-term mortality, with adjusted HRs of 1.27 (95 % CI 1.03–1.56;  P  = 0.023) for alkaline phosphatase and 1.22 (95 % CI 1.07–1.39;  P  = 0.003) for total bilirubin.    Conclusions  The present study demonstrates that elevated values of alkaline phosphatase and total bilirubin are sensitive parameters for predicting the short-term and long-term outcomes of ECMO patients.    Electronic supplementary material  The online version of this article (doi:10.1186/s13054-016-1242-4) contains supplementary material, which is available to authorized users.

Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery