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 - Publisher Copyright:
© 2020 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
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.
UR - http://www.scopus.com/inward/record.url?scp=85094969393&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/ca2473bb-079d-30e8-92aa-4b80bbe95c8b/
U2 - 10.1161/CIRCULATIONAHA.120.048792
DO - 10.1161/CIRCULATIONAHA.120.048792
M3 - Journal articles
C2 - 33032450
AN - SCOPUS:85094969393
SN - 0009-7322
VL - 142
SP - 2095
EP - 2106
JO - Circulation
JF - Circulation
IS - 22
ER -
