Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study.
Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study.
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DOI：
10.1161/circulationaha.120.048792
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发表时间：
2020-12
期刊：
影响因子：
37.8
通讯作者：
Westermann D
中科院分区：
文献类型：
--
作者：
Schrage B;Becher PM;Bernhardt A;Bezerra H;Blankenberg S;Brunner S;Colson P;Cudemus Deseda G;Dabboura S;Eckner D;Eden M;Eitel I;Frank D;Frey N;Funamoto M;Goßling A;Graf T;Hagl C;Kirchhof P;Kupka D;Landmesser U;Lipinski J;Lopes M;Majunke N;Maniuc O;McGrath D;Möbius-Winkler S;Morrow DA;Mourad M;Noel C;Nordbeck P;Orban M;Pappalardo F;Patel SM;Pauschinger M;Pazzanese V;Reichenspurner H;Sandri M;Schulze PC;H G Schwinger R;Sinning JM;Aksoy A;Skurk C;Szczanowicz L;Thiele H;Tietz F;Varshney A;Wechsler L;Westermann D
补充数字内容可在正文中找到。静脉动脉体外膜氧合(VA-ECMO)越来越多地用于治疗心源性休克。然而，VA-ECMO可能会阻碍心肌的恢复。伊佩拉卸载了左心室。本研究旨在评估使用VA-ECMO治疗的心源性休克患者的左心室卸载是否与较低的死亡率相关。收集了来自4个国家的16个三级护理中心的686名连续接受VA-ECMO治疗的心源性休克患者的数据，无论是否使用Impella左心卸载。在1：1倾向得分匹配的队列中，用COX回归模型评估左心室负荷与30天死亡率之间的关系。在686例患者中，有337例(49%)采用了左心室卸载。配对后，255例有左室卸载者与255例无左室卸载者进行比较。在匹配的队列中，左心室卸载与较低的30天死亡率相关(风险比，0.79[95%CI，0.63-0.98]；P=0.03)，不同亚组之间没有差异。严重出血98例(38.4%)对45例(17.9%)，入路部位相关缺血55例(21.6%)对31例(12.3%)，腹腔室间隔23例(9.4%)对9例(3.7%)，肾脏替代治疗148例(58.5%)对99例(39.1%)。在这项国际多中心队列研究中，尽管并发症发生率较高，但接受VA-ECMO治疗的心源性休克患者的左心室卸载与较低的死亡率有关。这些发现支持在使用VA-ECMO治疗心源性休克的患者中使用左心室卸载，并呼吁进一步验证，理想的情况是在随机对照试验中。
Supplemental Digital Content is available in the text. 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. 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. 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%). 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.