Background. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. Methods. Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (>= 70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (>= 18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications. Results. The mean age of the patient cohort (n [ 5,408) was 53.0 +/- 15.7years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 +/- 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMOfor postcardiotomy support comparedwith 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly groupwas 101 +/- 91hcomparedwith 138 +/- 146hin the younger group (p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival. Conclusions. Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. (C) 2017 by The Society of Thoracic Surgeons