Antonopoulos Michael, Koliopoulou Antigone, Elaiopoulos Dimitrios, Kolovou Kyriaki, Doubou Dimitra, Smyrli Anna, Zavaropoulos Prodromos, Kogerakis Nektarios, Fragoulis Sokratis, Perreas Konstantinos, Stavridis Georgios, Adamopoulos Stamatis, Chamogeorgakis Themistocles, Dimopoulos Stavros
Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece.
2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
Hellenic J Cardiol. 2024 Sep 30. doi: 10.1016/j.hjc.2024.09.006.
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols, and its use has been rising worldwide in the last decade. Although experience and availability are growing, outcomes remain poor. There is need for evidence to improve clinical practice and outcomes.
We retrospectively reviewed the medical records of all patients who were supported with VA ECMO for cardiogenic shock at our institution between January 2015 and January 2023. The study purpose was to compare outcomes between patients who were supported with central versus peripheral configuration.
ECMO was applied in 108 patients, 48 (44%) of whom received central configuration and 60 (56%) peripheral. Patients supported with central VA ECMO were more likely to be supported for post-cardiotomy shock (odds ratio [OR] 4.6 [95% confidence interval (CI) 2.03-10.41]), while patients in the peripheral group were predominantly treated for chronic heart failure decompensation (OR 9.4 [95% CI 1.16-76.3]). Central VA ECMO had lower survival rates during ECMO support (29.2% versus 51.7%, p = 0.018) and at discharge (8% versus 37%, p = 0.001). These patients were at high risk of complications, such as acute kidney injury (AKI) (OR 2.37 [95% CI 1.06-5.3], p = 0.034) and major bleeding (OR 3.08 [95% CI 1.36-6.94], p < 0.001).
Patients on central VA ECMO were supported mainly for post-cardiotomy shock, presented with more complications such as major bleeding and AKI, and had worse survival to hospital discharge compared with patients on peripheral VA ECMO. Patient selection, timing of implementation, cannulation strategy, and configuration remain the main determinants of clinical outcome.
静脉-动脉体外膜肺氧合（VA ECMO）已成为对标准治疗方案难治的心源性休克患者的一种有效抢救治疗方法，在过去十年中其在全球的使用一直在增加。尽管经验和可及性不断增长，但预后仍然很差。需要证据来改善临床实践和预后。
我们回顾性分析了2015年1月至2023年1月期间在我院接受VA ECMO支持治疗心源性休克的所有患者的病历。研究目的是比较接受中心配置与外周配置支持的患者的预后。
108例患者接受了ECMO治疗，其中48例（44%）接受中心配置，60例（56%）接受外周配置。接受中心VA ECMO支持的患者更有可能因心脏术后休克接受支持（比值比[OR]4.6[95%置信区间（CI）2.03 - 10.41]），而外周组患者主要因慢性心力衰竭失代偿接受治疗（OR 9.4[95% CI 1.16 - 76.3]）。中心VA ECMO在ECMO支持期间的生存率较低（29.2%对51.7%，p = 0.018），出院时生存率也较低（8%对37%，p = 0.001）。这些患者发生并发症的风险较高，如急性肾损伤（AKI）（OR 2.37[95% CI 1.06 - 5.3]，p = 0.034）和大出血（OR 3.08[95% CI 1.36 - 6.94]，p < 0.001）。
与接受外周VA ECMO的患者相比，接受中心VA ECMO的患者主要因心脏术后休克接受支持，出现更多并发症，如大出血和AKI，出院生存率更差。患者选择、实施时机、插管策略和配置仍然是临床结局的主要决定因素。
