Mechanical Left Ventricular Unloading in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.
Mechanical Left Ventricular Unloading in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.
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DOI：
10.1016/j.jacc.2022.01.032
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发表时间：
2022-04-05
影响因子：
24
通讯作者：
Garan, A. Reshad
中科院分区：
文献类型：
--
作者：
Grandin, E. Wilson;Nunez, Jose, I;Willar, Brooks;Kennedy, Kevin;Rycus, Peter;Tonna, Joseph E.;Kapur, Navin K.;Shaefi, Shahzad;Garan, A. Reshad
关键词：
静脉动脉体外膜氧合(VA-ECMO)增加了左心室(LV)后负荷，潜在地引起LV扩张和损害恢复。使用主动脉内球囊反搏(IABP)或经皮室管辅助装置(PVAD)进行左心室机械卸载(MU)可以防止左室扩张，但可能存在更多并发症的风险，临床净效益仍不确定。本研究旨在确定接受VA-ECMO的患者的MU与预后之间的关系。作者查询了2010-2019年接受外周VA-ECMO的成年人的体外生命支持组织登记，并按患有IABP或PVAD的MU进行分层。主要结果是住院死亡率；次要结果包括VA-ECMO期间的支持下死亡率和并发症。在12734例VA-ECMO患者中，3399例(26.7%)接受了MU：2782例(82.9%)接受了IABP，580例(17.1%)接受了PVAD。MU患者年龄较大(56.3vs52.7岁)，在体外膜氧合前，更多地使用>；2血管升压剂(41.7%vs27.2%)，有呼吸(21.1%vs15.9%)，肾脏(24.6%vs15.8%)和肝功能衰竭(4.4%vs3.1%)(均P<；0.001)。MU患者住院病死率较低(56.6%vs59.3%，P=0.006)，坚持多因素建模(调整后OR0.84；95%CI：0.77~0.92；P<；0.001)。MU与插管部位出血(AOR：1.2 5；95%CI：1.11~1.4 0；P<；0.001)和溶血(AOR：1.2 7；95%CI：1.0 3~1.5 7；P=0.0 2)有关。与PVAD相比，合并IABP的MU患者病死率相似(AOR：0.80；95%CI：0.64~1.01；P=0.06)，而内科出血(AOR：0.45；95%CI：0.31~0.64；P<；0.001)、插管部位出血(AOR：0.72；95%CI：0.54~0.96；P=0.03)、肾损害(AOR：0.78；95%CI：0.62~0.98；P=0.03)较少。在接受VA-ECMO的成人中，尽管溶血和插管部位出血等并发症增加，但MU与较低的住院死亡率有关。与PVAD相比，MU合并IABP具有相似的死亡率和较低的并发症发生率。
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases left ventricular (LV) afterload, potentially provoking LV distention and impairing recovery. LV mechanical unloading (MU) with intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD) can prevent LV distension, potentially at the risk of more complications, and net clinical benefit remains uncertain. This study aims to determine the association between MU and outcomes for patients undergoing VA-ECMO. The authors queried the Extracorporeal Life Support Organization registry for adults receiving peripheral VA-ECMO from 2010 to 2019 and stratified them by MU with IABP or pVAD. The primary outcome was in-hospital mortality; secondary outcomes included on-support mortality and complications during VA-ECMO. Among 12,734 VA-ECMO patients, 3,399 (26.7%) received MU: 2,782 (82.9%) IABP and 580 (17.1%) pVAD. MU patients were older (age 56.3 vs 52.7 years) and, before extracorporeal membrane oxygenation, more often required >2 vasopressors (41.7% vs 27.2%) and had respiratory (21.1% vs 15.9%), renal (24.6% vs 15.8%), and liver failure (4.4% vs 3.1%) (all P < 0.001). MU patients had lower in-hospital mortality (56.6% vs 59.3%, P = 0.006), which persisted in multivariable modeling (adjusted OR [aOR]: 0.84; 95% CI: 0.77–0.92; P < 0.001). MU was associated with more cannula site bleeding (aOR: 1.25; 95% CI: 1.11–1.40; P < 0.001) and hemolysis (aOR: 1.27; 95% CI: 1.03–1.57; P = 0.02). Compared to pVAD, MU patients with IABP had similar mortality (aOR: 0.80; 95% CI: 0.64–1.01; P = 0.06) and less medical bleeding (aOR: 0.45; 95% CI: 0.31–0.64; P < 0.001), cannula site bleeding (aOR: 0.72; 95% CI: 0.54–0.96; P = 0.03), and renal injury (aOR: 0.78; 95% CI: 0.62–0.98; P = 0.03). Among adults receiving VA-ECMO, MU was associated with lower in-hospital mortality despite increased complications including hemolysis and cannulation site bleeding. Compared to pVAD, MU with IABP was associated with similar mortality and lower complication rates.
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影响因子：
37.8
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Westermann D
影响因子：
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通讯作者：
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