TY - JOUR
T1 - 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
AU - Schrage, Benedikt
AU - Becher, Peter Moritz
AU - Bernhardt, Alexander
AU - Bezerra, Hiram
AU - Blankenberg, Stefan
AU - Brunner, Stefan
AU - Colson, Pascal
AU - Deseda, Gaston Cudemus
AU - Dabboura, Salim
AU - Eckner, Dennis
AU - Eden, Matthias
AU - Eitel, Ingo
AU - Frank, Derk
AU - Frey, Norbert
AU - Funamoto, Masaki
AU - Goßling, Alina
AU - Graf, Tobias
AU - Hagl, Christian
AU - Kirchhof, Paulus
AU - Kupka, Danny
AU - Landmesser, Ulf
AU - Lipinski, Jerry
AU - Lopes, Mathew
AU - Majunke, Nicolas
AU - Maniuc, Octavian
AU - McGrath, Daniel
AU - Möbius-Winkler, Sven
AU - Morrow, David A.
AU - Mourad, Marc
AU - Noel, Curt
AU - Nordbeck, Peter
AU - Orban, Martin
AU - Pappalardo, Federico
AU - Patel, Sandeep M.
AU - Pauschinger, Matthias
AU - Pazzanese, Vittorio
AU - Reichenspurner, Hermann
AU - Sandri, Marcus
AU - Schulze, P. Christian
AU - Schwinger, Robert H.G.
AU - Sinning, Jan Malte
AU - Aksoy, Adem
AU - Skurk, Carsten
AU - Szczanowicz, Lukasz
AU - Thiele, Holger
AU - Tietz, Franziska
AU - Varshney, Anubodh
AU - Wechsler, Lukas
AU - Westermann, Dirk
N1 - Funding Information:
This study was funded by the University Heart and Vascular Center Hamburg. Dr Schrage was funded by the German Research Foundation and the Else Kröner-Fresenius-Stiftung.
Publisher Copyright:
© 2020 The Authors
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. 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.
AB - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. 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.
KW - cardiogenic
KW - extracorporeal membrane oxygenation
KW - shock
UR - http://www.scopus.com/inward/record.url?scp=85094969393&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.120.048792
DO - 10.1161/CIRCULATIONAHA.120.048792
M3 - Article
C2 - 33032450
AN - SCOPUS:85094969393
SN - 0009-7322
VL - 142
SP - 2095
EP - 2106
JO - Circulation
JF - Circulation
IS - 22
ER -