Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation
Benedikt Schrage
(1, 2)
,
Peter Moritz Becher
(1, 2)
,
Alexander Bernhardt
(1, 2)
,
Hiram Bezerra
(3)
,
Stefan Blankenberg
(1, 2)
,
Stefan Brunner
(4)
,
Pascal Colson
(5, 6)
,
Gaston Cudemus Deseda
(7)
,
Salim Dabboura
(1, 2)
,
Dennis Eckner
(8)
,
Matthias Eden
(2, 9)
,
Ingo Eitel
(2, 9)
,
Derk Frank
(2, 9)
,
Norbert Frey
(2, 9)
,
Masaki Funamoto
(7)
,
Alina Gossling
(1, 2)
,
Tobias Graf
(2, 9)
,
Christian Hagl
(4)
,
Paulus Kirchhof
(1, 2, 10, 11)
,
Danny Kupka
(1, 4)
,
Ulf Landmesser
(2, 12)
,
Jerry Lipinski
(13)
,
Mathew Lopes
(14)
,
Nicolas Majunke
(15, 16)
,
Octavian Maniuc
(4, 17)
,
Daniel Mcgrath
(7)
,
Sven Möbius-Winkler
(18)
,
David A Morrow
(14)
,
Marc Mourad
(5)
,
Curt Noel
(2, 9)
,
Peter Nordbeck
(17)
,
Martin Orban
,
Federico Pappalardo
(19, 20)
,
Sandeep M Patel
(21)
,
Matthias Pauschinger
(8)
,
Vittorio Pazzanese
(19)
,
Hermann Reichenspurner
(1)
,
Marcus Sandri
(15, 16)
,
P. Christian Schulze
(18)
,
Robert H.G. Schwinger
(22)
,
Jan-Malte Sinning
(23)
,
Adem Aksoy
(23)
,
Carsten Skurk
(2, 12)
,
Lukasz Szczanowicz
(15, 16)
,
Holger Thiele
(15, 16)
,
Franziska Tietz
(15, 16)
,
Anubodh Varshney
(14)
,
Lukas Wechsler
(22)
,
Dirk Westermann
(2)
1
University Heart Center [Hamburg]
2 DZHK - German Center for Cardiovascular Research
3 USF - University of South Florida [Tampa]
4 Klinikum der Ludwig-Maximilians-Universität
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
6 IGF - Institut de Génomique Fonctionnelle
7 Massachusetts General Hospital [Boston]
8 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
9 UKSH - University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein
10 University of Birmingham [Birmingham]
11 University Hospitals Birmingham [Birmingham, Royaume-Uni]
12 Charité - UniversitätsMedizin = Berlin University Medicine
13 UC San Diego - University of California [San Diego]
14 BWH - Brigham & Women’s Hospital [Boston]
15 Heart Centre Leipzig
16 Leipzig University / Universität Leipzig
17 University Hospital of Würzburg
18 Jena University Hospital [Jena]
19 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
20 IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico
21 St. Rita's Medical Center [Lima]
22 Klinikum Weiden
23 University Hospital Bonn
2 DZHK - German Center for Cardiovascular Research
3 USF - University of South Florida [Tampa]
4 Klinikum der Ludwig-Maximilians-Universität
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
6 IGF - Institut de Génomique Fonctionnelle
7 Massachusetts General Hospital [Boston]
8 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
9 UKSH - University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein
10 University of Birmingham [Birmingham]
11 University Hospitals Birmingham [Birmingham, Royaume-Uni]
12 Charité - UniversitätsMedizin = Berlin University Medicine
13 UC San Diego - University of California [San Diego]
14 BWH - Brigham & Women’s Hospital [Boston]
15 Heart Centre Leipzig
16 Leipzig University / Universität Leipzig
17 University Hospital of Würzburg
18 Jena University Hospital [Jena]
19 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
20 IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico
21 St. Rita's Medical Center [Lima]
22 Klinikum Weiden
23 University Hospital Bonn
Benedikt Schrage
- Fonction : Auteur
- PersonId : 807906
- ORCID : 0000-0001-9041-3922
Pascal Colson
- Fonction : Auteur
- PersonId : 915100
Martin Orban
- Fonction : Auteur
Holger Thiele
- Fonction : Auteur
- PersonId : 772045
- ORCID : 0000-0002-0169-998X
Dirk Westermann
- Fonction : Auteur
- PersonId : 798488
- ORCID : 0000-0002-7542-1956
Résumé
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.
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