Complications in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy: distribution and relevance. Results from an international, multicentre cohort study.
VA-ECMO
adverse events
cardiogenic shock
complications
mechanical circulatory support
neurological outcome
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
24 Oct 2023
24 Oct 2023
Historique:
received:
24
07
2023
revised:
16
09
2023
accepted:
20
10
2023
medline:
25
10
2023
pubmed:
25
10
2023
entrez:
24
10
2023
Statut:
aheadofprint
Résumé
VA-ECMO restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications. To quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (CPC 1 + 2). All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in 4 countries (2005-2019). Neurological, bleeding and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications. N = 501. 118 were women (24%), median age was 56.0 years, median lactate 8.1 mmol/l. Acute myocardial infarction caused CS in 289 patients (58%). 30-day mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor. Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
Sections du résumé
BACKGROUND
BACKGROUND
VA-ECMO restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications.
OBJECTIVES
OBJECTIVE
To quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (CPC 1 + 2).
METHODS
METHODS
All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in 4 countries (2005-2019). Neurological, bleeding and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications.
RESULTS
RESULTS
N = 501. 118 were women (24%), median age was 56.0 years, median lactate 8.1 mmol/l. Acute myocardial infarction caused CS in 289 patients (58%). 30-day mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor.
CONCLUSIONS
CONCLUSIONS
Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
Identifiants
pubmed: 37875127
pii: 7329286
doi: 10.1093/ehjacc/zuad129
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.