Impact of Venoarterial Extracorporeal Membrane Oxygenation Flow on Outcomes in Cardiogenic Shock.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 02 2022
01 02 2022
Historique:
pubmed:
17
8
2021
medline:
2
2
2022
entrez:
16
8
2021
Statut:
ppublish
Résumé
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is used to provide cardiopulmonary support in cardiogenic shock; however, high extracorporeal flow may increase left ventricular (LV) afterload leading to LV distention and intracardiac stasis. It is unclear how ECMO flow affects patient outcomes and complications related to ECMO. Retrospective review of patients at a single institution placed on VA ECMO from 2007 to 2018 was performed. Patients were divided into full flow (flow index > 2.2 L/min/m2) and partial flow (flow index < 2.2 L/min/m2) groups. In-hospital mortality and markers of end-organ perfusion were compared between groups balanced for risk factors using propensity score inverse probability of treatment weighting. ECMO-related complications such as LV distention, limb ischemia, and bleeding were recorded. There were 488 patients included, 405 (83%) in the partial flow group, and 83 (17%) in the full flow group. No major differences in age, gender, or comorbidities were found. There was no difference in in-hospital mortality between groups (51% vs. 55%, p = 0.59). At 72 hours post-ECMO initiation, there was no difference in the change in renal, hepatic function, or lactate from baseline nor in the rates of continuous venoveno hemofiltration initiation (p = 0.41). There was a trend towards the decreased incidence of LV distention requiring LV vent placement in the partial flow group (12% vs. 7%, p = 0.16). Compared with full flow VA ECMO, partial flow VA ECMO in carefully selected patients results in similar in-hospital mortality and provides similar end-organ perfusion for the treatment of refractory cardiogenic shock.
Identifiants
pubmed: 34398539
doi: 10.1097/MAT.0000000000001462
pii: 00002480-202202000-00016
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
239-246Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Fux T, Holm M, Corbascio M, Lund LH, van der Linden J: VA-ECMO support in nonsurgical patients with refractory cardiogenic shock: pre-implant outcome predictors. Artif Organs 2019.43: 132–141
Whitman GJ: Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock. J Thorac Cardiovasc Surg 2017.153: 95–101
Lorusso R, Raffa GM, Alenizy K, et al.: Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1—Adult patients. J HeartLung Transplantation 2019.38: 1125–1143
Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD: Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail 2018.11: e004905
Donker DW, Brodie D, Henriques JPS, Broomé M: Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion 2019.34: 98–105
Lim HS: The effect of impella CP on cardiopulmonary physiology during venoarterial extracorporeal membrane oxygenation support. Artif Organs 2017.41: 1109–1112
Truby LK, Takeda K, Mauro C, et al.: Incidence and implications of left ventricular distention during venoarterial extracorporeal membrane oxygenation support. ASAIO J 2017.63: 257–265
Cevasco M, Takayama H, Ando M, Garan AR, Naka Y, Takeda K: Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation. J Thorac Dis 2019.11: 1676–1683
Seino Y: Cardiac function and peripheral circulatory adjustments in patients with acute myocardial infarction. Observations during the early stage of AMI. Jpn Heart J 1983.24: 515–528
Takayama H, Landes E, Truby L, et al.: Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2015.149: 1428–1433
Austin PC: The performance of different propensity-score methods for estimating differences in proportions (risk differences or absolute risk reductions) in observational studies. Stat Med 2010.29: 2137–2148
Lee BK, Lessler J, Stuart EA: Improving propensity score weighting using machine learning. Stat Med 2010.29: 337–346
Silber J, Rosenbaum P, Trudeau M, et al.: Multivariate Matching and Bias Reduction in the Surgical Outcomes Study. Med Care 2001.39: 1048–1064
Mundy L, Truby L, Hongo T, et al.: The Columbia experience of 163 patients with venoarterial extracorporeal membranous oxygenation for refractory cardiogenic shock. J Heart Lung Transplantation 2014.33: S38–S39
Dickstein ML: The starling relationship and veno-arterial ECMO: ventricular distension explained. ASAIO J 2018.64: 497–501
Takayama H, Truby L, Koekort M, et al.: Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant 2013.32: 106–111
Flécher E, Anselmi A, Corbineau H, et al.: Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up. Eur J Cardiothorac Surg 2014.46: 665–671
Cheng R, Hachamovitch R, Kittleson M, et al.: Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014.97: 610–616
Shah M, Patil S, Patnaik S, et al.: Outcomes in cardiogenic shock from acute coronary syndrome depending on severity of obesity. Am J Cardiol 2019.123: 1267–1272
Bonicolini E, Martucci G, Simons J, et al.: Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment. Crit Care 2019.23: 266