Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation
| Autor: | Masaki Funamoto, Peter Moritz Becher, Curt Noel, Gaston A Cudemus Deseda, Dirk Westermann, P. Christian Schulze, Benedikt Schrage, Marcus Sandri, Derk Frank, Marc Mourad, Sandeep M. Patel, Franziska Tietz, Sven Möbius-Winkler, Matthias Pauschinger, Daniel Mcgrath, Paulus Kirchhof, Lukasz Szczanowicz, Vittorio Pazzanese, Alina Goßling, Stefan Brunner, Robert H. G. Schwinger, David A. Morrow, Christian Hagl, Alexander M. Bernhardt, Jan Malte Sinning, Ingo Eitel, Tobias Graf, Nicolas Majunke, Stefan Blankenberg, Matthias Eden, Peter Nordbeck, Octavian Maniuc, Adem Aksoy, Mathew S Lopes, Pascal Colson, Carsten Skurk, Federico Pappalardo, Norbert Frey, Salim Dabboura, Danny Kupka, Dennis Eckner, Ulf Landmesser, Anubodh S. Varshney, Martin Orban, Jerry Lipinski, Hermann Reichenspurner, Lukas Wechsler, Holger Thiele, Hiram G. Bezerra |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Cardiogenic shock 030204 cardiovascular system & hematology medicine.disease 3. Good health 03 medical and health sciences 0302 clinical medicine Physiology (medical) Internal medicine medicine Cardiology Extracorporeal membrane oxygenation In patient 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Lower mortality Impella Cohort study |
| Zdroj: | Circulation. 142:2095-2106 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | 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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