| Autor: |
Udongwo, Ndausung, Narra, LakshmiRekha, Mararenko, Anton, Alshami, Abbas, Fatuyi, Michael, Abe, Temidayo, Olanipekun, Titilope, Upadhyaya, Vandan D, Dhulipala, Vishal, Dominic, Jerry, kurtz, jack, Kossack, Andrew, Saybolt, Matthew, Selan, Jeffrey, Sealove, Brett, Singh, Deepak, Almendral, Jesus |
| Zdroj: |
Circulation (Ovid); November 2022, Vol. 146 Issue: Supplement 1 pA332-A332, 1p |
| Abstrakt: |
Introduction:Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used in patients with cardiogenic shock. However, this strategy can lead to left ventricular (LV) distention, thus compromising myocardial recovery. Therefore, concomitant LV unloading with an Impella device (Abiomed, Danvers, MA) has gained a wide interest to promote LV recovery. We aimed to investigate the in-hospital outcomes of patients with myocardial infarction and cardiogenic shock undergoing VA-ECMO with Impella (ECPELLA) versus VA-ECMO alone.Methods:We conducted a retrospective cohort study using the 2019 National Inpatient Sample Database. Variables were identified using their International Classification of Diseases, 10th revision (ICD-10) codes. Descriptive bivariate and multivariate analyses were performed. A p-value <0.05 was considered statistically significant.Results:A total of 1915 records of acute myocardial infarction and cardiogenic shock treated with VA-ECMO were identified. Of these, 625 underwent ECPELLA, and 1,290 underwent VA-ECMO alone. Baseline characteristics and complication rates are listed in Table 1. Inpatient mortality rate was not statistically different between the ECPELLA and the VA-ECMO groups [50.4% (n=315) vs 46.1% (n=595), respectively, p=0.08]. In addition, a multivariable logistic regression model adjusting for potential confounders (baseline characteristics in Table 1, as well as primary expected payer, left heart catheterization, and initial presentation with cardiac arrest) did not show a mortality benefit for ECPELLA over VA-ECMO (OR 1.206, 95% CI 0.967-1.50, p=0.097). However, rates of acute renal failure requiring hemodialysis and intracranial hemorrhage were lower in the ECPELLA group.Conclusion:Our data suggests that there is no survival to hospital discharge benefit for ECPELLA vs VA-ECMO. Prospective studies are warranted to validate our findings.. |
| Databáze: |
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