Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy.
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Schrage Benedikt, Sundermeyer Jonas, Blankenberg Stefan, Colson Pascal, Eckner Dennis, Eden Matthias, Eitel Ingo, Frank Derk, Frey Norbert, Graf Tobias, Kirchhof Paulus, Kupka Danny, Landmesser Ulf, Linke Axel, Majunke Nicolas, Mangner Norman, Maniuc Octavian, Mierke Johannes, Möbius-Winkler Sven, Morrow David A, Mourad Marc, Nordbeck Peter, Orban Martin, Pappalardo Federico, Patel Sandeep M, Pauschinger Matthias, Pazzanese Vittorio, Radakovic Darko, Schulze P Christian, Scherer Clemens, Schwinger Robert H G, Skurk Carsten, Thiele Holger, Varshney Anubodh, Wechsler Lukas, Westermann Dirk
Аннотация
OBJECTIVES: This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS.
METHODS: Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation.
RESULTS: Overall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading.
CONCLUSIONS: This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial.