1 Medical-Surgical ICU, Hôpital Pitié-Salpêtrière, France.
2 INSERM U1050, Centre Interdisciplinaire de Recherche en Biologie, France.
Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):62-69. doi: 10.1177/2048872617711169. Epub 2017 Jun 2.
Increased left ventricular afterload during peripheral venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support frequently causes hydrostatic pulmonary oedema. Because physiological studies demonstrated left ventricular afterload decrease during VA-ECMO assistance combined with the intra-aortic balloon pump (IABP), we progressively changed our standard practice systematically to associate an IABP with VA-ECMO. This study aimed to evaluate IABP efficacy in preventing pulmonary oedema in VA-ECMO-assisted patients.
A retrospective single-centre study.
Among 259 VA-ECMO patients included, 104 received IABP. Weinberg radiological score-assessed pulmonary oedema was significantly lower in IABP than IABP patients at all times after ECMO implantation. This protection against pulmonary oedema persisted when death and switching to central ECMO were used as competing risks (subhazard ratio 0.49, 95% confidence interval (CI) 0.33-0.75; P<0.001). Multivariable analysis retained IABP as being independently associated with a lower risk of radiological pulmonary oedema (odds ratio (OR) 0.4, 95% CI 0.2-0.7; P=0.001) and a trend towards lower mortality (OR 0.54, 95% CI 0.29-1.01; P=0.06). Finally, the time on ECMO free from mechanical ventilation increased in IABP patients (2.2±4.3 vs. 0.7±2.0 days; P=0.0003). Less frequent pulmonary oedema and more days off mechanical ventilation were also confirmed in 126 highly comparable IABP and IABP patients, propensity score matched for receiving an IABP.
Associating an IABP with peripheral VA-ECMO was independently associated with a lower frequency of hydrostatic pulmonary oedema and more days off mechanical ventilation under ECMO.
在外周静脉-动脉体外膜肺氧合（VA-ECMO）支持期间，左心室后负荷增加常导致肺充血性水肿。由于生理研究表明，VA-ECMO 辅助时结合主动脉内球囊泵（IABP）可降低左心室后负荷，因此我们系统地逐步改变了标准实践，将 IABP 与 VA-ECMO 联合应用。本研究旨在评估 IABP 在预防 VA-ECMO 辅助患者肺水肿中的疗效。
这是一项回顾性单中心研究。
在纳入的 259 例 VA-ECMO 患者中，有 104 例接受了 IABP。Weinberg 影像学评分评估的肺水肿在 ECMO 植入后所有时间点均显著低于 IABP 患者。当将死亡和转为中心 ECMO 作为竞争风险时，这种对肺水肿的保护仍然存在（亚危险比 0.49，95%置信区间 [CI] 0.33-0.75；P<0.001）。多变量分析保留了 IABP 与较低的影像学肺水肿风险独立相关（比值比 [OR] 0.4，95%CI 0.2-0.7；P=0.001），且死亡率呈下降趋势（OR 0.54，95%CI 0.29-1.01；P=0.06）。最后，IABP 患者 ECMO 期间无机械通气的时间增加（2.2±4.3 与 0.7±2.0 天；P=0.0003）。在 126 例高度匹配的接受 IABP 和未接受 IABP 的患者中，也确认了较少发生肺水肿和更多天数脱离机械通气。
外周 VA-ECMO 联合使用 IABP 与肺充血性水肿发生率降低和 ECMO 下机械通气时间减少独立相关。
