Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock
Por:
Montero, S, Huang, F, Rivas-Lasarte, M, Chommeloux, J, Demondion, P, Brechot, N, Hekimian, G, Franchineau, G, Persichini, R, Luyt, CE, Garcia-Garcia, C, Bayes-Genis, A, Lebreton, G, Cinca, J, Leprince, P, Combes, A, Alvarez-Garcia, J and Schmidt, M
Publicada:
1 ago 2021
Ahead of Print:
1 abr 2021
Resumen:
Background Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is currently one of the first-line therapies for refractory cardiogenic shock (CS), but its applicability is undermined by the high morbidity associated with its complications, especially those related to mechanical ventilation (MV). We aimed to assess the prognostic impact of keeping patients in refractory CS awake at cannulation and during the VA-ECMO run.
Methods A 7-year database of patients given peripheral VA-ECMO support was used to conduct a propensity-score (PS)-matched analysis to balance their clinical profiles. Patients were classified as 'awake ECMO' or 'non-awake ECMO', respectively, if invasive MV was used during <= 50% or >50% of the VA-ECMO run. Primary outcomes included ventilator-associated pneumonia and ECMO-related complication rates, and secondary outcomes were 60-day and 1-year mortality. A multivariate logistic-regression analysis was used to identify whether MV at cannulation was independently associated with 60-day mortality.
Results Among 231 patients included, 91 (39%) were 'awake' and 140 (61%) 'non-awake'. After PS-matching adjustment, the 'awake ECMO' group had significantly lower rates of pneumonia (35% vs. 59%, P=0.017), tracheostomy, renal replacement therapy, and less antibiotic and sedative consumption. This strategy was also associated with reduced 60-day (20% vs. 41%, P=0.018) and 1-year mortality rates (31% vs. 54%, P=0.021) compared to the 'non-awake' group, respectively. Lastly, MV at ECMO cannulation was independently associated with 60-day mortality.
Conclusion An 'awake ECMO' management in VA-ECMO-supported CS patients is feasible, safe, and associated with improved short- and long-term outcomes.
Filiaciones:
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Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Dept Med, Acute Cardiovasc Care Unit,Cardiol, Barcelona, Spain
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Huang, F:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Rivas-Lasarte, M:
Univ Autonoma Barcelona, Cardiol Dept, CIBERCV, IIb SantPau,Hosp Santa Creu & St Pau, Barcelona, Spain
Chommeloux, J:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Demondion, P:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Thorac & Cardiovasc Dept, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Brechot, N:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Hekimian, G:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Franchineau, G:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Persichini, R:
CHU Reunion, Med Surg Intens Care Unit, Reun, Felix Guyon Hosp, St Denis, Reunion, France
Luyt, CE:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
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Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Dept Med, Acute Cardiovasc Care Unit,Cardiol, Barcelona, Spain
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Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Dept Med, Acute Cardiovasc Care Unit,Cardiol, Barcelona, Spain
Lebreton, G:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Thorac & Cardiovasc Dept, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Cinca, J:
Univ Autonoma Barcelona, Cardiol Dept, CIBERCV, IIb SantPau,Hosp Santa Creu & St Pau, Barcelona, Spain
Leprince, P:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Thorac & Cardiovasc Dept, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Combes, A:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Sorbonne Univ, Assistance Publ Hop Paris APHP, RESPIRE, GRC 30,Hop Pitie Salpetriere, Paris, France
Alvarez-Garcia, J:
Univ Autonoma Barcelona, Cardiol Dept, CIBERCV, IIb SantPau,Hosp Santa Creu & St Pau, Barcelona, Spain
Schmidt, M:
Hop La Pitie Salpetriere, Assistance Publ Hop Paris, Med Intens Care Unit, F-75651 Paris 13, France
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM UMRS 1166 ICAN, F-75651 Paris 13, France
Sorbonne Univ, Assistance Publ Hop Paris APHP, RESPIRE, GRC 30,Hop Pitie Salpetriere, Paris, France
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