Radakovic Dejan, Penov Kiril, Hamouda Khaled, Madrahimov Nodir, Radakovic Darko, Bening Constanze, Leyh Rainer G, Aleksic Ivan
Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, 97080 Würzburg, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
Life (Basel). 2022 Aug 5;12(8):1195. doi: 10.3390/life12081195.
The benefit of the combined use of an intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy shock remains unclear. We aimed to analyse the potential benefits and safety of combining these two devices.
We enrolled 200 patients treated with either VA-ECMO only or in combination with IABP (ECMO-I group) between January 2012 and January 2021. To adjust the patients' backgrounds, we used propensity score matching for additional analyses, resulting in 57 pairs. The primary endpoint was 30-day survival. Secondary endpoints included successful weaning and complication rates. We also analysed hemodynamic parameters in both groups.
After propensity score matching, 30-day survival was better in the ECMO-I group (log-rank = 0.004). The ECMO-I and ECMO-only groups differed regarding the secondary endpoints, including successful weaning (50.9% and 26.3%, respectively; = 0.012) and the need for continuous renal replacement therapy (28.1% and 50.9%, = 0.021). Complication rates were not statistically different between the two groups.
Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is beneficial regarding 30-day survival in selected patients with postcardiotomy shock; successful ECMO weaning and freedom from renal replacement therapy is more common in patients supported with VA-ECMO plus IABP.
主动脉内球囊反搏（IABP）与静脉-动脉体外膜肺氧合（VA-ECMO）联合用于心脏术后休克的益处尚不清楚。我们旨在分析联合使用这两种设备的潜在益处和安全性。
我们纳入了2012年1月至2021年1月期间仅接受VA-ECMO治疗或联合IABP治疗（ECMO-I组）的200例患者。为了调整患者背景，我们使用倾向评分匹配进行额外分析，最终得到57对。主要终点是30天生存率。次要终点包括成功撤机和并发症发生率。我们还分析了两组的血流动力学参数。
倾向评分匹配后，ECMO-I组的30天生存率更高（对数秩检验=0.004）。ECMO-I组和单纯ECMO组在次要终点方面存在差异，包括成功撤机（分别为50.9%和26.3%；P=0.012）以及持续肾脏替代治疗的需求（28.1%和50.9%，P=0.021）。两组的并发症发生率无统计学差异。
与单独使用VA-ECMO相比，对于部分心脏术后休克患者，联合使用VA-ECMO和IABP在30天生存率方面有益；在接受VA-ECMO加IABP支持的患者中，成功撤机和无需肾脏替代治疗更为常见。
