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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; [...]

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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  • Medientyp: E-Artikel
  • Titel: 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 : Results From an International, Multicenter Cohort Study
  • Beteiligte: 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; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2020
  • Erschienen in: Circulation
  • Sprache: Englisch
  • DOI: 10.1161/circulationaha.120.048792
  • ISSN: 0009-7322; 1524-4539
  • Schlagwörter: Physiology (medical) ; Cardiology and Cardiovascular Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec> <jats:title>Background:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> 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]; <jats:italic>P</jats:italic> =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%). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>
  • Zugangsstatus: Freier Zugang