Use of Extracorporeal Membrane Oxygenation as Bridge to Replacement Therapies in Cardiogenic Shock: Insights From the Extracorporeal Life Support Organization.
Use of Extracorporeal Membrane Oxygenation as Bridge to Replacement Therapies in Cardiogenic Shock: Insights From the Extracorporeal Life Support Organization.
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DOI：
10.1161/circheartfailure.121.008777
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Shah Z
中科院分区：
文献类型：
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作者：
Mastoris I;Tonna JE;Hu J;Sauer AJ;Haglund NA;Rycus P;Wang Y;Wallisch WJ;Abicht TO;Danter MR;Tedford RJ;Fang JC;Shah Z
补充数字内容可在文本中找到。在过去的十年中，体外膜肺氧合（ECMO）作为心脏移植（原位心脏移植[OHT]）或左心室辅助装置（LVAD）的桥梁的使用越来越多。我们的目的是提供关于每种治疗选择的人群、结局和预测因素的见解。使用2010年至2019年的体外生命支持组织登记，我们比较了住院死亡率和住院时间，OHT与LVAD的预测因素，以及ECMO桥接至OHT或LVAD的心源性休克患者的住院死亡率预测因素。167例患者接受LVAD，234例患者接受OHT。ECMO的总体使用率从2010年的1.7%增加到2019年的22.2%。两组的死亡率相似（LVAD：28.7% vs OHT：29.1%），而OHT的住院时间更长（LVAD：49.6 vs OHT：59.5天，P=0.05）。与OHT相关的因素包括既往移植（比值比[OR]=31.26 [CI，3.84-780.5]），使用临时起搏器（OR=6.5 [CI，1.39-50.15]），并增加ECMO上使用正性肌力药物（OR=3.77 [CI，1.39-11.07]），而LVAD的使用与体重相关（OR=0.98 [CI，0.97-0.99]），心源性休克表现（OR=0.40 [CI，0.21-0.78]）、既往LVAD（OR=0.01 [CI，0.0001-0.22]）、呼吸衰竭（OR=0.28 [CI，0.11-0.70]）和米力农输注（OR=0.32 [CI，0.15-0.67]）。年龄较大（OR=1.07 [CI，1.02-1.12]），插管出血（OR=26.1 [CI，4.32-221.3]）和手术出血（OR=6.7 [CI，1.26-39.9]）接受OHT治疗的患者中，OR=5 [CI，1.17-23.1]和连续性肾脏替代治疗（OR=3.82 [CI，1.28-11.9]）与死亡率增加相关。随着时间的推移，ECMO作为先进治疗的桥梁越来越多，接受LVAD的患者多于OHT。两组的死亡率相等，而OHT的住院时间较长。
Supplemental Digital Content is available in the text. There has been increasing use of extracorporeal membrane oxygenation (ECMO) as bridge to heart transplant (orthotopic heart transplant [OHT]) or left ventricular assist device (LVAD) over the last decade. We aimed to provide insights on the population, outcomes, and predictors for the selection of each therapy. Using the Extracorporeal Life Support Organization Registry between 2010 and 2019, we compared in-hospital mortality and length of stay, predictors of OHT versus LVAD, and predictors of in-hospital mortality for patients with cardiogenic shock that were bridged with ECMO to OHT or LVAD. One hundred sixty-seven patients underwent LVAD versus 234 patients who underwent OHT. The overall use of ECMO has increased from 1.7% in 2010 to 22.2% in 2019. Mortality was similar between groups (LVAD: 28.7% versus OHT: 29.1%) while length of stay was longer for OHT (LVAD: 49.6 versus OHT: 59.5 days, P=0.05). Factors associated with OHT included prior transplant (odds ratio [OR]=31.26 [CI, 3.84–780.5]), use of a temporary pacemaker (OR=6.5 [CI, 1.39–50.15]), and increased use of inotropes on ECMO (OR=3.77 [CI, 1.39–11.07]), whereas LVAD use was associated with weight (OR=0.98 [CI, 0.97–0.99]), cardiogenic shock presentation (OR=0.40 [CI, 0.21–0.78]), previous LVAD (OR=0.01 [CI, 0.0001–0.22]), respiratory failure (OR=0.28 [CI, 0.11–0.70]), and milrinone infusion (OR=0.32 [CI, 0.15–0.67]). Older age (OR=1.07 [CI, 1.02–1.12]), cannulation bleeding (OR=26.1 [CI, 4.32–221.3]), and surgical bleeding (OR=6.7 [CI, 1.26–39.9]) in patients receiving LVAD and respiratory failure (OR=5 [CI, 1.17–23.1]) and continuous renal replacement therapy (OR=3.82 [CI, 1.28–11.9]) in patients receiving OHT were associated with increased mortality. ECMO use as a bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the 2 groups while length of stay was longer for OHT.