Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study
Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study
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DOI：
10.1016/s0140-6736(20)30733-9
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发表时间：
2020-08-22
期刊：
影响因子：
168.9
通讯作者：
Combes, Alain
中科院分区：
文献类型：
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作者：
Brechot, Nicolas;Hajage, David;Combes, Alain
背景败血症性心肌病合并心源性休克患者死亡率高。本研究评估了静脉体外膜氧合（VA-ECMO）对常规治疗难治性败血症性心源性休克的支持。方法在这项回顾性、多中心、国际队列研究中，我们比较了在5个学术ECMO中心接受VA-ECMO治疗的82例脓毒性休克患者（年龄0 = 18岁）和从3个大型脓毒性休克数据库获得的130例对照组（未接受ECMO）的结果。所有患者在纳入时均有严重的心肌功能障碍（心脏指数3 L/min /m(2)或以下或左心室射血分数[LVEF] 35%或以下）和严重的血流动力学损害（肌力评分至少为75 μ g/kg /min或乳酸血症至少为4 mmol/L）。主要终点为90天生存率。进行倾向评分加权分析以控制混杂因素。在基线时，接受VA-ECMO治疗的患者有更严重的心肌功能障碍(平均心脏指数1.5 L/min /m (2) vs 2.2 L/min /m (2), LVEF 17% vs 27%)，更严重的血流动力学损害（肌力评分279 μ g/kg /min vs 145 μ g/kg /min，乳酸血症8.9 mmol/L vs 6.5 mmol/L），更严重的器官衰竭（序贯器官衰竭评估评分17 vs 13）
Background Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments.Methods In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged >= 18 years) with septic shock who received VA-ECMO at five academic ECMO centres, with 130 controls (not receiving ECMO) obtained from three large databases of septic shock. All patients had severe myocardial dysfunction (cardiac index 3 L/min per m(2) or less or left ventricular ejection fraction [LVEF] 35% or less) and severe haemodynamic compromise (inotrope score at least 75 mu g/kg per min or lactic acidaemia at least 4 mmol/L) at time of inclusion. The primary endpoint was survival at 90 days. A propensity score-weighted analysis was done to control for confounders.Findings At baseline, patients treated with VA-ECMO had more severe myocardial dysfunction (mean cardiac index 1.5 L/min per m(2) vs 2.2 L/min per m(2), LVEF 17% vs 27%), more severe haemodynamic impairment (inotrope score 279 mu g/kg per min vs 145 mu g/kg per min, lactataemia 8.9 mmol/L vs 6.5 mmol/L), and more severe organ failure (Sequential Organ Failure Assessment score 17 vs 13) than did controls, with p