ECMO management in cardiogenic shock-specialized versus non-cardiogenic shock-specialized centers: a registry-based analysis.

BACKGROUND

Data on the impact of center specialization on extracorporeal membrane oxygenation (ECMO) management in cardiogenic shock (CS) remain limited. This study aimed to evaluate differences in outcomes and management of patients with CS receiving ECMO in CS-specialized versus non-CS-specialized centers.

METHODS

This registry-based study used data from the Chinese Society of Extracorporeal Life Support (CSECLS) registry. Adult patients diagnosed with CS and treated with ECMO were included. ECMO centers were categorized as CS-specialized or non-specialized based on the responsible department. Propensity score matching (PSM) was conducted to balance patient characteristics and center experience. The primary endpoint was in-hospital mortality.

RESULTS

A total of 1,415 adult patients were included from January 1, 2017, to December 31, 2021 (523 in CS-specialized centers, 892 in non-CS-specialized centers). The mean age was 53.2 ± 16.1 years, and 30.3% of patients were female. In-hospital mortality was lower in CS-specialized centers both before (P = 0.001) and after adjustment (P = 0.035). Patients in CS-specialized centers more frequently received intra-aortic balloon pumps (38.5% vs. 30.4%; P = 0.009), and were less likely to require mechanical ventilation (80.6% vs. 90.7%; P < 0.001) or continuous renal replacement therapy (42.7% vs. 49.8%; P = 0.030) than those in non-CS-specialized centers.

CONCLUSIONS

Treatment in CS-specialized centers was independently associated with lower in-hospital mortality among patients receiving ECMO for circulatory support, even after adjusting for both patient-level characteristics and center-level experience.