Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

Autor: Schrage, Benedikt, Becher, Peter, Bernhardt, Alexander, Bezerra, Hiram, Blankenberg, Stefan, Brunner, Stefan, Colson, Pascal, Cudemus Deseda, Gaston, Dabboura, Salim, Eckner, Dennis, Eden, Matthias, Eitel, Ingo, Frank, Derk, Frey, Norbert, Funamoto, Masaki, Goßling, Alina, Graf, Tobias, Hagl, Christian, Kirchhof, Paulus, Kupka, Danny, Landmesser, Ulf, Lipinski, Jerry, Lopes, Mathew, Majunke, Nicolas, Maniuc, Octavian, McGrath, Daniel, Möbius-Winkler, Sven, Morrow, David, Mourad, Marc, Noel, Curt, Nordbeck, Peter, Orban, Martin, Pappalardo, Federico, Patel, Sandeep, Pauschinger, Matthias, Pazzanese, Vittorio, Reichenspurner, Hermann, Sandri, Marcus, Schulze, P. Christian, H.G. Schwinger, Robert, Sinning, Jan-Malte, Aksoy, Adem, Skurk, Carsten, Szczanowicz, Lukasz, Thiele, Holger, Tietz, Franziska, Varshney, Anubodh, Wechsler, Lukas, Westermann, Dirk
Přispěvatelé: University Heart Center [Hamburg], German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), University of South Florida [Tampa] (USF), Klinikum der Ludwig-Maximilians-Universität, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de Génomique Fonctionnelle (IGF), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Massachusetts General Hospital [Boston], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, University of Birmingham [Birmingham], University Hospitals Birmingham [Birmingham, Royaume-Uni], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], University of California [San Diego] (UC San Diego), University of California (UC), Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Heart Centre Leipzig, Universität Leipzig [Leipzig], University Hospital of Würzburg, Jena University Hospital [Jena], Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie] (UniSR), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), St. Rita's Medical Center [Lima], Klinikum Weiden, University Hospital Bonn, Herrada, Anthony, Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), University of California
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Circulation
Circulation, 2020, 142 (22), pp.2095-2106. ⟨10.1161/CIRCULATIONAHA.120.048792⟩
Circulation, American Heart Association, 2020, 142 (22), pp.2095-2106. ⟨10.1161/CIRCULATIONAHA.120.048792⟩
ISSN: 0009-7322
1524-4539
DOI: 10.1161/CIRCULATIONAHA.120.048792⟩
Popis: International audience; Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. Methods: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score–matched cohort. Results: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63–0.98]; P =0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site–related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). Conclusions: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
Databáze: OpenAIRE
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