Artificial organs · 2025
Comparison of Extracorporeal Membrane Oxygenation Initiation in Cardiogenic Shock During Work-Hours Versus After-Hours.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Li Chenglong, Wang Xiaomeng, Du Zhongtao, Lu Andong, Lyv Liwen, Zhang Sheng, Liu Jianling, Liu Yan, Zuo Liuer, Huang Yue, Li Binfei, Chang Ping, Yang Yi, Liu Jianhua, Huang Man, Xie Haixiu, Wang Liangshan, Yang Feng, Wang Hong, Hou Xiaotong, Chinese Society of Extracorporeal Life Support (CSECLS)
Аннотация
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as rescue therapy for cardiogenic shock (CS) is highly dependent on timeliness and medical resources.
OBJECTIVES: Aimed to assess ECMO management and outcomes in adult patients with CS in terms of on- and after-hour ECMO initiation from a national ECMO registry.
METHODS: Adult patients diagnosed with CS and those who received ECMO were enrolled in the study. The population was divided into the work-hours and the after-hours group based on the time of ECMO initiation. In-hospital mortality and ECMO management were compared between them. Electronic data in this research were provided by Chinese Society of Extracorporeal Life Support.
RESULTS: In a cohort of 1862 patients, 552 (29.6%) received ECMO during work-hours, whereas 1310 (70.4%) received ECMO during after-hours. After-hour ECMO had more patients with elective cardiac procedures (35.1% vs. 26.3%, p < 0.001) and higher severity (p < 0.001), with more patients with Society for Cardiovascular Angiography and Interventions shock stage D (29.6% vs. 24.5), E (60.0% vs. 51.8%), and fewer B (3.6% vs. 13.2%) and C (6.8% vs. 10.5%). A high proportion underwent intra-aortic balloon pump (IABP) implantation before ECMO (28.4% vs. 23.0%, p = 0.016) and mechanical ventilation (92.1% vs. 87.0%, p < 0.001) during after-hours. The in-hospital mortality in patients with after-hour ECMO initiation was higher than that in patients with work-hour ECMO initiation (51.8% vs. 45.3%, p = 0.011).
CONCLUSION: In this cohort, 70% were initiated during after-hours and showed higher in-hospital mortality than patients with work-hour ECMO initiation. After-hour ECMO initiation should be a concern for ECMO programs.
OBJECTIVES: Aimed to assess ECMO management and outcomes in adult patients with CS in terms of on- and after-hour ECMO initiation from a national ECMO registry.
METHODS: Adult patients diagnosed with CS and those who received ECMO were enrolled in the study. The population was divided into the work-hours and the after-hours group based on the time of ECMO initiation. In-hospital mortality and ECMO management were compared between them. Electronic data in this research were provided by Chinese Society of Extracorporeal Life Support.
RESULTS: In a cohort of 1862 patients, 552 (29.6%) received ECMO during work-hours, whereas 1310 (70.4%) received ECMO during after-hours. After-hour ECMO had more patients with elective cardiac procedures (35.1% vs. 26.3%, p < 0.001) and higher severity (p < 0.001), with more patients with Society for Cardiovascular Angiography and Interventions shock stage D (29.6% vs. 24.5), E (60.0% vs. 51.8%), and fewer B (3.6% vs. 13.2%) and C (6.8% vs. 10.5%). A high proportion underwent intra-aortic balloon pump (IABP) implantation before ECMO (28.4% vs. 23.0%, p = 0.016) and mechanical ventilation (92.1% vs. 87.0%, p < 0.001) during after-hours. The in-hospital mortality in patients with after-hour ECMO initiation was higher than that in patients with work-hour ECMO initiation (51.8% vs. 45.3%, p = 0.011).
CONCLUSION: In this cohort, 70% were initiated during after-hours and showed higher in-hospital mortality than patients with work-hour ECMO initiation. After-hour ECMO initiation should be a concern for ECMO programs.