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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Schrage Benedikt, Becher Peter Moritz, Bernhardt Alexander, Bezerra Hiram, Blankenberg Stefan, Brunner Stefan, Colson Pascal, Cudemus Deseda Gaston, Dabboura Salim, Eckner Dennis, Eden Matthias, Eitel Ingo, Frank Derk, Frey Norbert, Funamoto Masaki, Goßling Alina, Graf Tobias, Hagl Christian, Kirchhof Paulus, Kupka Danny, Landmesser Ulf, Lipinski Jerry, Lopes Mathew, Majunke Nicolas, Maniuc Octavian, McGrath Daniel, Möbius-Winkler Sven, Morrow David A, Mourad Marc, Noel Curt, Nordbeck Peter, Orban Martin, Pappalardo Federico, Patel Sandeep M, Pauschinger Matthias, Pazzanese Vittorio, Reichenspurner Hermann, Sandri Marcus, Schulze P Christian, H G Schwinger Robert, Sinning Jan-Malte, Aksoy Adem, Skurk Carsten, Szczanowicz Lukasz, Thiele Holger, Tietz Franziska, Varshney Anubodh, Wechsler Lukas, Westermann Dirk
Аннотация
METHODS: 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.
RESULTS: 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%).
CONCLUSIONS: 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.