Ontology highlight
ABSTRACT:
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.
SUBMITTER: Schrage B
PROVIDER: S-EPMC7688081 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Schrage Benedikt B Becher Peter Moritz PM Bernhardt Alexander A Bezerra Hiram H Blankenberg Stefan S Brunner Stefan S Colson Pascal P Cudemus Deseda Gaston G Dabboura Salim S Eckner Dennis D Eden Matthias M Eitel Ingo I Frank Derk D Frey Norbert N Funamoto Masaki M Goßling Alina A Graf Tobias T Hagl Christian C Kirchhof Paulus P Kupka Danny D Landmesser Ulf U Lipinski Jerry J Lopes Mathew M Majunke Nicolas N Maniuc Octavian O McGrath Daniel D Möbius-Winkler Sven S Morrow David A DA Mourad Marc M Noel Curt C Nordbeck Peter P Orban Martin M Pappalardo Federico F Patel Sandeep M SM Pauschinger Matthias M Pazzanese Vittorio V Reichenspurner Hermann H Sandri Marcus M Schulze P Christian PC H G Schwinger Robert R Sinning Jan-Malte JM Aksoy Adem A Skurk Carsten C Szczanowicz Lukasz L Thiele Holger H Tietz Franziska F Varshney Anubodh A Wechsler Lukas L Westermann Dirk D
Circulation 20201009 22
<h4>Background</h4>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.<h4>Methods</h4>Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricula ...[more]