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.

Adult Aged Cohort Studies Extracorporeal Membrane Oxygenation / mortality Female Humans Internationality Male Middle Aged Mortality / trends Shock, Cardiogenic / diagnosis Treatment Outcome Ventricular Function, Left / physiology
extracorporeal membrane oxygenation shock, cardiogenic

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
12 2020
Historique:
pubmed: 10 10 2020
medline: 12 10 2021
entrez: 9 10 2020
Statut: ppublish

Résumé

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. 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. 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]; 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.

Sections du résumé

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];
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.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.120.048792 PMID: 33032450 PMC: PMC7688081
pubmed: 33032450
doi: 10.1161/CIRCULATIONAHA.120.048792
pmc: PMC7688081
doi:

Types de publication

Clinical Trial Journal Article Multicenter Study Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2095-2106

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn

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Auteurs

Benedikt Schrage (B)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).

Peter Moritz Becher (PM)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).

Alexander Bernhardt (A)

Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).

Hiram Bezerra (H)

Tampa General Hospital, University of South Florida (H.B.).

Stefan Blankenberg (S)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).

Stefan Brunner (S)

Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.

Pascal Colson (P)

Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.).

Gaston Cudemus Deseda (G)

Division of Anesthesia, Critical Care and Pain Medicine (G.C.D.), Massachusetts General Hospital, Boston.

Salim Dabboura (S)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.

Dennis Eckner (D)

Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.).

Matthias Eden (M)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.).

Ingo Eitel (I)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.).

Derk Frank (D)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.).

Norbert Frey (N)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.).

Masaki Funamoto (M)

Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston.

Alina Goßling (A)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.

Tobias Graf (T)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.).

Christian Hagl (C)

Herzchirurgische Klinik und Poliklinik (C.H.), LMU Klinikum, Munich, Germany.

Paulus Kirchhof (P)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham National Health ServiceTrusts, United Kingdom (P.K.).

Danny Kupka (D)

Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.

Ulf Landmesser (U)

Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).
Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.).

Jerry Lipinski (J)

Department of Internal Medicine, University of California, San Diego (J.L.).

Mathew Lopes (M)

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).

Nicolas Majunke (N)

Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).

Octavian Maniuc (O)

Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.
Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.).

Daniel McGrath (D)

Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston.

Sven Möbius-Winkler (S)

Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.).

David A Morrow (DA)

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).

Marc Mourad (M)

Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.).

Curt Noel (C)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.).

Peter Nordbeck (P)

Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.).

Martin Orban (M)

Federico Pappalardo (F)

Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).
Department of Anesthesia and Intensive Care, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) ISMETT (Istituto Mediterraneo trapianti e terapie avanzate), UPMC (University of Pittsburgh Medical Center)Italy, Palermo, Italy (F.P.).

Sandeep M Patel (SM)

Department of Interventional Cardiology, St. Rita's Medical Center, Lima, OH (S.M.P.).

Matthias Pauschinger (M)

Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.).

Vittorio Pazzanese (V)

Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).

Hermann Reichenspurner (H)

Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.

Marcus Sandri (M)

Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).

P Christian Schulze (PC)

Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.).

Robert H G Schwinger (R)

Medizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.).

Jan-Malte Sinning (JM)

University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.).

Adem Aksoy (A)

University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.).

Carsten Skurk (C)

Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).
Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.).

Lukasz Szczanowicz (L)

Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).

Holger Thiele (H)

Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).

Franziska Tietz (F)

Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).

Anubodh Varshney (A)

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).

Lukas Wechsler (L)

Medizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.).

Dirk Westermann (D)

German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Procédures de chirurgie opératoire › Circulation extracorporelle › Oxygénation extracorporelle sur oxygénateur à membrane › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Sciences sociales › Internationalité › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Choc › Choc cardiogénique › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Left Ventricular Unloading Is Associated With...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire gauche › Left Ventricular Unloading Is Associated With...