Modi Shan P, Hong Yeahwa, Sicke McKenzie M, Hess Nicholas R, Klass Wyatt J, Ziegler Luke A, Rivosecchi Ryan M, Hickey Gavin W, Kaczorowski David J, Ramanan Raj
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
JTCVS Open. 2023 Dec 21;17:152-161. doi: 10.1016/j.xjon.2023.12.005. eCollection 2024 Feb.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with concomitant percutaneous microaxial left ventricular assist device support is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with this support strategy have not been well described.
This study was a retrospective, single-center analysis of patients with CS due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support from December 2020 to January 2023.
A total of 44 patients were included (AMI-CS, n = 20, and ADHF-CS, n = 24). Patients with AMI-CS and ADHF-CS had similar survival at 90 days postdischarge ( = .267) with similar destinations after support ( = .220). Patients with AMI-CS initially supported with VA-ECMO were less likely to survive 90 days postdischarge ( = .038) when compared with other cohorts. Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS ( =.013; = .030). Subanalysis of ADHF-CS patients into acute-on-chronic decompensated HF and de novo HF demonstrated no difference in survival or destination.
VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS with this support strategy. AMI-CS patients with initial VA-ECMO support have increased mortality in comparison to other cohorts. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with this support strategy.
静脉-动脉体外膜肺氧合（VA-ECMO）联合经皮微轴左心室辅助装置支持是一种用于心源性休克（CS）的新兴治疗方式。关于这种支持策略下心源性休克病因的生存结果尚未得到充分描述。
本研究是一项回顾性单中心分析，纳入了2020年12月至2023年1月期间接受VA-ECMO联合经皮微轴左心室辅助装置支持的急性心肌梗死所致心源性休克（AMI-CS）或失代偿性心力衰竭所致心源性休克（ADHF-CS）患者。
共纳入44例患者（AMI-CS，n = 20；ADHF-CS，n = 24）。AMI-CS和ADHF-CS患者出院后90天的生存率相似（P = 0.267），支持后的转归相似（P = 0.220）。与其他队列相比，初始接受VA-ECMO支持的AMI-CS患者出院后90天存活的可能性较小（P = 0.038）。AMI-CS患者肢体缺血和急性肾损伤的发生率更高（P = 0.013；P = 0.030）。将ADHF-CS患者亚分析为慢性失代偿性心力衰竭急性加重和新发心力衰竭，结果显示生存率或转归无差异。
VA-ECMO联合经皮微轴左心室辅助装置支持可成功用于治疗CS患者。采用这种支持策略时，AMI-CS和ADHF-CS患者的生存率或转归无差异。与其他队列相比，初始接受VA-ECMO支持的AMI-CS患者死亡率更高。未来需要多中心研究来全面分析采用这种支持策略时AMI-CS和ADHF-CS之间的差异。
