Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea; Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
JACC Cardiovasc Interv. 2021 May 24;14(10):1109-1119. doi: 10.1016/j.jcin.2021.03.048.
The aim of this study was to investigate whether earlier extracorporeal membrane oxygenation (ECMO) support is associated with improved clinical outcomes in patients with refractory cardiogenic shock (CS).
The prognosis of patients with refractory CS receiving ECMO remains poor. However, little is known about the association between the timing of ECMO implantation and clinical outcomes in these patients.
From a multicenter registry, 362 patients with refractory CS who underwent ECMO between January 2014 and December 2018 were identified. Participants were classified into 3 groups according to tertiles of shock-to-ECMO time (early, intermediate, and late ECMO). Inverse probability of treatment weighting was conducted to adjust for baseline differences among the groups, followed by a weighted Cox proportional hazards regression analysis to calculate hazard ratios and 95% confidence intervals for 30-day mortality associated with each ECMO time group.
The overall 30-day mortality rate was 40.9%. The risk for 30-day mortality was lower in the early group than in the late group (hazard ratio: 0.53; 95% confidence interval: 0.28 to 0.99). Early ECMO support was also associated with lower risk for in-hospital mortality, ECMO weaning failure, composite of all-cause mortality or rehospitalization for heart failure at 1 year, all-cause mortality at 1 year, and poor neurological outcome at discharge. However, the incidence of adverse events, including stroke, limb ischemia, ECMO-site bleeding, and gastrointestinal bleeding, did not differ significantly among the groups.
Earlier ECMO support was associated with improved clinical outcomes in patients with refractory CS.
本研究旨在探讨体外膜肺氧合（ECMO）支持的起始时间是否与难治性心源性休克（CS）患者的临床结局改善相关。
接受 ECMO 的难治性 CS 患者的预后仍然较差。然而，对于这些患者 ECMO 植入时机与临床结局之间的关系，我们知之甚少。
从一个多中心登记处中，确定了 2014 年 1 月至 2018 年 12 月期间接受 ECMO 的 362 例难治性 CS 患者。根据休克至 ECMO 时间的三分位数，将参与者分为 3 组（早期、中期和晚期 ECMO）。采用逆概率治疗加权法调整组间基线差异，然后进行加权 Cox 比例风险回归分析，计算每个 ECMO 时间组与 30 天死亡率相关的风险比和 95%置信区间。
总的 30 天死亡率为 40.9%。早期组 30 天死亡率的风险低于晚期组（风险比：0.53；95%置信区间：0.28 至 0.99）。早期 ECMO 支持还与住院期间死亡率、ECMO 撤机失败、1 年内全因死亡率或因心力衰竭再住院、1 年内全因死亡率以及出院时不良神经结局的风险降低相关。然而，各组之间不良事件（包括中风、肢体缺血、ECMO 部位出血和胃肠道出血）的发生率无显著差异。
更早的 ECMO 支持与难治性 CS 患者的临床结局改善相关。
