Suzuki Sho, Ito Kii, Teraoka Nami, Okuma Yukari, Kimura Kazuhiro, Minamisawa Masatoshi, Ebisawa Soichiro, Motoki Hirohiko, Imamura Hiroshi, Seto Tatsuichiro, Kuwahara Koichiro
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
ESC Heart Fail. 2024 Dec;11(6):3767-3774. doi: 10.1002/ehf2.14931. Epub 2024 Jul 11.
Knowing the upper time limit for successful weaning from temporary mechanical circulatory support in cardiogenic shock will help with decision-making regarding advanced heart failure (HF) therapy or considering withdrawal of care. The aim of this study was to investigate the association between the support duration and successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock.
A retrospective single-centre cohort study was conducted between January 2013 and June 2023. It included 100 consecutive patients with cardiogenic shock who were treated with VA-ECMO. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was successful weaning from VA-ECMO (i.e., VA-ECMO decannulation and survival to discharge). The association between the length of support duration and the weaning success rate was analysed. Patients were divided into three groups according to ECMO support duration: Group A (≤7 days), Group B (8-14 days), and Group C (≥15 days). Multivariable logistic regression analysis was used to evaluate the impact of the length of support duration on successful weaning of VA-ECMO. The median age was 67 years, and 73% of study participants were male. The underlying aetiologies of cardiogenic shock were as follows: acute myocardial infarction, 50; fulminant myocarditis, 19; cardiomyopathy, 15; valvular heart disease, 8; and other, 8. Seventy-five patients (75%) were attempted to wean VA-ECMO, and 67 moved on to decannulation. In total, 43 (43%) patients were successfully weaned from VA-ECMO. The median length of ECMO support duration was 8 [3-15] days. Compared with those who underwent successful ECMO decannulation, those who did not had a significantly longer support duration of VA-ECMO (5 [3-9] days vs. 12 [3-22] days, P = 0.004). The weaning success rate was significantly higher in patients with short support duration; 58% (29/50), 40% (10/25), 16% (4/25) in Groups A, B, and C, respectively (P = 0.002). Overall, none of the patients supported for over 24 days (0/11) were successfully weaned from VA-ECMO. On multivariable logistic regression analysis, the length of support duration was independently associated with successful weaning after adjusting for age, sex, underlying aetiology, and left ventricular ejection fraction (odds ratio, 0.813 [per 3 days]; 95% confidence interval, 0.679-0.914; P = 0.025).
Long support duration of VA-ECMO was significantly associated with a low rate of successful weaning in patients with cardiogenic shock. Patients who require VA-ECMO for over 1 week should start considering advanced HF therapy or withdrawal of care.
明确心源性休克患者成功撤离临时机械循环支持的最长时间限制，将有助于指导晚期心力衰竭（HF）治疗的决策制定或考虑终止治疗。本研究旨在调查心源性休克患者的支持持续时间与成功撤离静脉-动脉体外膜肺氧合（VA-ECMO）之间的关联。
2013年1月至2023年6月进行了一项回顾性单中心队列研究。纳入100例接受VA-ECMO治疗的连续性心源性休克患者。排除院外心脏骤停患者。主要结局为成功撤离VA-ECMO（即VA-ECMO拔管并存活至出院）。分析支持持续时间与撤离成功率之间的关联。根据ECMO支持持续时间将患者分为三组：A组（≤7天）、B组（8 - 14天）和C组（≥15天）。采用多变量逻辑回归分析评估支持持续时间对成功撤离VA-ECMO的影响。中位年龄为67岁，73%的研究参与者为男性。心源性休克的潜在病因如下：急性心肌梗死50例；暴发性心肌炎19例；心肌病15例；瓣膜性心脏病8例；其他8例。75例（75%）患者尝试撤离VA-ECMO，67例进入拔管阶段。总共有43例（43%）患者成功撤离VA-ECMO。ECMO支持持续时间的中位数为8[3 - 15]天。与成功进行ECMO拔管的患者相比，未成功拔管的患者VA-ECMO支持持续时间显著更长（5[3 - 9]天 vs. 12[3 - 22]天，P = 0.004）。支持持续时间短的患者撤离成功率显著更高；A组、B组和C组分别为58%（29/50）、40%（10/25）、16%（4/25）（P = 0.002）。总体而言，接受支持超过24天的患者无一例（0/11）成功撤离VA-ECMO。在多变量逻辑回归分析中，调整年龄、性别、潜在病因和左心室射血分数后，支持持续时间与成功撤离独立相关（比值比，0.813[每3天]；95%置信区间，0.679 - 0.914；P = 0.025）。
心源性休克患者VA-ECMO支持持续时间长与成功撤离率低显著相关。需要VA-ECMO支持超过1周的心衰患者应开始考虑晚期HF治疗或终止治疗。
