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Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

Authors :
Masaki Funamoto
Peter Moritz Becher
Curt Noel
Gaston A Cudemus Deseda
Dirk Westermann
P. Christian Schulze
Benedikt Schrage
Marcus Sandri
Derk Frank
Marc Mourad
Sandeep M. Patel
Franziska Tietz
Sven Möbius-Winkler
Matthias Pauschinger
Daniel Mcgrath
Paulus Kirchhof
Lukasz Szczanowicz
Vittorio Pazzanese
Alina Goßling
Stefan Brunner
Robert H. G. Schwinger
David A. Morrow
Christian Hagl
Alexander M. Bernhardt
Jan Malte Sinning
Ingo Eitel
Tobias Graf
Nicolas Majunke
Stefan Blankenberg
Matthias Eden
Peter Nordbeck
Octavian Maniuc
Adem Aksoy
Mathew S Lopes
Pascal Colson
Carsten Skurk
Federico Pappalardo
Norbert Frey
Salim Dabboura
Danny Kupka
Dennis Eckner
Ulf Landmesser
Anubodh S. Varshney
Martin Orban
Jerry Lipinski
Hermann Reichenspurner
Lukas Wechsler
Holger Thiele
Hiram G. Bezerra
Source :
Circulation. 142:2095-2106
Publication Year :
2020
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2020.

Abstract

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.

Details

ISSN :
15244539 and 00097322
Volume :
142
Database :
OpenAIRE
Journal :
Circulation
Accession number :
edsair.doi...........9a2099615cb0b443aed237e793d5eaa7