体外膜肺氧合在心源性休克中的应用：来自THEME注册研究的见解。

Utilization of TandemHeart in cardiogenic shock: Insights from the THEME registry.

作者信息

Megaly Michael, Gandolfo Chaun, Zakhour Samer, Jiang Mei, Burgess Kristie, Chetcuti Stanley, Ragosta Michael, Adler Eric, Coletti Andrew, O'Neill Brian, Alaswad Khaldoon, Basir Mir B

机构信息

Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA.

LivaNova, PLC, London, UK.

出版信息

Catheter Cardiovasc Interv. 2023 Mar;101(4):756-763. doi: 10.1002/ccd.30582. Epub 2023 Feb 7.

DOI:10.1002/ccd.30582

PMID:36748804

Abstract

BACKGROUND

TandemHeart has been demonstrated to improve hemodynamic and metabolic complications in cardiogenic shock (CS). Contemporary outcomes have not been reported.

OBJECTIVES

To evaluate the outcomes of the TandemHeart (LivaNova) in contemporary real-world use.

METHODS

We analyzed baseline characteristics, hemodynamic changes, and outcomes of all patients treated with TandemHeart who were enrolled in the THEME registry, a multicenter, prospective, observational study.

RESULTS

Between May 2015 and June 2019, 50 patients underwent implantation of the TandemHeart device. 22% of patients had TandemHeart implanted within 12 h, 32% within 24 h, and 52% within 48 h of CS diagnosis. Cardiac index (CI) was significantly improved 24 h after implantation (median change 1.0, interquartile range (IQR) (0.5-1.4 L/min/m ). In survivors, there was a significant improvement in CI (1.0, IQR (0.5-2.25 L/min/m ) and lactate clearance -2.3 (-5.0 to -0.7 mmol/L). The 30-day and 180-day survival were 74% (95% confidence interval: 60%-85%) and 66% (95% confidence interval: 51%-79%), respectively. Survival was similarly high in those in whom TandemHeart has been used as a bridge to surgery (85% 180-day survival).

CONCLUSION

In a contemporary cohort of patients presenting in CS, the use of TandemHeart is associated with a 74% 30-day survival and a 66% 180-day survival.

摘要

背景

串联式人工心脏已被证明可改善心源性休克（CS）的血流动力学和代谢并发症。目前尚未报道其当代应用结果。

目的

评估串联式人工心脏（LivaNova公司生产）在当代实际应用中的结果。

方法

我们分析了纳入THEME注册研究的所有接受串联式人工心脏治疗患者的基线特征、血流动力学变化和结果，该研究是一项多中心、前瞻性、观察性研究。

结果

2015年5月至2019年6月期间，50例患者接受了串联式人工心脏装置植入。22%的患者在CS诊断后12小时内植入串联式人工心脏，32%在24小时内，52%在48小时内。植入后24小时心脏指数（CI）显著改善（中位数变化1.0，四分位间距（IQR）（0.5 - 1.4L/min/m）。在幸存者中，CI有显著改善（1.0，IQR（0.5 - 2.25L/min/m）），乳酸清除率为 - 2.3（-5.0至 - 0.7mmol/L）。30天和180天生存率分别为74%（95%置信区间：60% - 85%）和66%（95%置信区间：51% - 79%）。将串联式人工心脏用作手术桥梁的患者生存率同样较高（180天生存率为85%）。