Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation.
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 04 2023
01 04 2023
Historique:
pmc-release:
01
04
2024
medline:
3
4
2023
pubmed:
3
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients. Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded. A total of 245 patients were included, with a median age of 59 years [IQR: 48-67]; 159 (65%) were male. There were 34 (14%) patients in Stage C, 82 (33%) in D, and 129 (53%) in E. Of E patients, 88 (68%) were undergoing cardiopulmonary resuscitation. Median ECMO duration decreased with stage (C:7, D:6, E:4 days, P < 0.001). In-hospital mortality increased (C:35%, D:56%, E:71%, P < 0.001) and myocardial recovery decreased with stage (C:65%, D:35%, E:30%, P < 0.001). Acute kidney injury (C:35%, D:45%, E:54%, P = 0.045), acute liver failure (C:32%, D:66%, E:76%, P < 0.001), and infection (C:35%, D:28%, E:16%, P = 0.004) varied among groups. Multivariable analysis revealed age (HR=1.02), male sex (HR=0.62), and E classification (HR=2.69) as independently associated with 1-year mortality. Competing-risks regression identified D (SHR=0.53) and E classification (SHR=0.45) as inversely associated with myocardial recovery. In patients treated with VA-ECMO for CS, the SCAI classification provided robust risk stratification.
Identifiants
pubmed: 36730984
doi: 10.1097/MAT.0000000000001813
pii: 00002480-202304000-00003
pmc: PMC10065877
mid: NIHMS1831426
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
352-359Subventions
Organisme : NHLBI NIH HHS
ID : T35 HL007616
Pays : United States
Informations de copyright
Copyright © ASAIO 2022.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
van Diepen S, Katz JN, Albert NM, et al.; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline: Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 136: e232–e268, 2017.
Jneid H., Alam M. Cardiogenic Shock. In Cardiology Secrets (pp. 143–149). WB Saunders. 2014.
Jeger RV, Radovanovic D, Hunziker PR, et al.; AMIS Plus Registry Investigators: Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med 149: 618–626, 2008.
Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S: Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock: An Introduction for the Busy Clinician. Circulation 140: 2019–2037, 2019.
Persico N, Bourenne J, Roch A: Veno-arterial extracorporeal membrane oxygenation for acute myocardial infarction-associated cardiogenic shock: can we predict survival before decision of implantation? J Thorac Dis 8: 2331–2333, 2016.
Baran DA, Grines CL, Bailey S, et al.: SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheterization and Cardiovascular Interventions, 94, 29–37,2019.
Schrage B, Dabboura S, Yan I, et al.: Application of the SCAI classification in a cohort of patients with cardiogenic shock. Catheter Cardiovasc Interv 96: E213–E219, 2020.
Jentzer JC, Baran DA, van Diepen S, et al.: Admission Society for Cardiovascular Angiography and Intervention shock stage stratifies post-discharge mortality risk in cardiac intensive care unit patients. Am Heart J 219: 37–46, 2020.
Garan AR, Takeda K, Salna M, et al.: Prospective Comparison of a Percutaneous Ventricular Assist Device and Venoarterial Extracorporeal Membrane Oxygenation for Patients With Cardiogenic Shock Following Acute Myocardial Infarction. J Am Heart Assoc 8: e012171, 2019.
Char S, Fried J, Melehy A, et al.: Clinical efficacy of direct or indirect left ventricular unloading during venoarterial extracorporeal membrane oxygenation for primary cardiogenic shock. The Journal of Thoracic and Cardiovascular Surgery 2021.
DeRoo SC, Takayama H, Nemeth S, et al.: Extracorporeal membrane oxygenation for primary graft dysfunction after heart transplant. J Thorac Cardiovasc Surg 158: 1576–1584.e3, 2019.
Thayer KL, Zweck E, Ayouty M, et al.: Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock. Circ Heart Fail 13: e007099, 2020.
Hanson ID, Tagami T, Mando R, et al.; National Cardiogenic Shock Investigators: SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 96: 1137–1142, 2020.
Singh SK, Ning Y, Kurlansky P, et al.: Impact of Venoarterial Extracorporeal Membrane Oxygenation Flow on Outcomes in Cardiogenic Shock. ASAIO J 68: 239–246, 2022.
Jeon CY, Neidell M, Jia H, Sinisi M, Larson E: On the role of length of stay in healthcare-associated bloodstream infection. Infect Control Hosp Epidemiol 33: 1213–1218, 2012.
Sun HY, Ko WJ, Tsai PR, et al.: Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 140: 1125–32.e2, 2010.
Omar HR, Mirsaeidi M, Mangar D, Camporesi EM: Duration of ECMO Is an Independent Predictor of Intracranial Hemorrhage Occurring During ECMO Support. ASAIO J 62: 634–636, 2016.