The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2025
Clinical outcomes of cardiogenic shock patients supported with VA-ECMO: Insights from the Cardiogenic Shock Working Group.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hernandez-Montfort Jaime, John Kevin J, Goldstein Daniel, Lorusso Roberto, Sinha Shashank S, Goodman Rachel, Natov Peter, Li Song, Li Borui, Kanwar Manreet, Garan Arthur Reshad, Abraham Jacob, Kong Qiuyue, Sangal Paavni, Walec Karol, Mahr Claudius, Rali Aniket, Burkhoff Daniel, Kapur Navin K, CSWG Academic Research Consortium
Аннотация
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for cardiogenic shock (CS) is increasing worldwide despite conflicting results from randomized trials, which focused on myocardial infarction-related CS (MI-CS).
METHODS: We performed a retrospective analysis of the Cardiogenic Shock Working Group multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions. Group comparisons used the Student's t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.
RESULTS: Between 2019 and 2023, 1,728 out of 11,244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p < 0.01). Heart replacement therapy was more common among HF-CS patients (24% vs 7%, HF vs MI-CS, p < 0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (14% overall, 10% vs 17%, HF vs MI-CS, p < 0.01), bleeding (53% overall, 47% vs 56%, HF vs MI-CS, p < 0.01), and stroke (13% overall, 10% vs 16%, HF vs MI-CS, p < 0.01).
CONCLUSIONS: Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO. These findings may inform future shock trial designs.
METHODS: We performed a retrospective analysis of the Cardiogenic Shock Working Group multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions. Group comparisons used the Student's t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.
RESULTS: Between 2019 and 2023, 1,728 out of 11,244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p < 0.01). Heart replacement therapy was more common among HF-CS patients (24% vs 7%, HF vs MI-CS, p < 0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (14% overall, 10% vs 17%, HF vs MI-CS, p < 0.01), bleeding (53% overall, 47% vs 56%, HF vs MI-CS, p < 0.01), and stroke (13% overall, 10% vs 16%, HF vs MI-CS, p < 0.01).
CONCLUSIONS: Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO. These findings may inform future shock trial designs.