Yamada Nobuhiro, Ueno Masafumi, Onishi Kyohei, Sugimoto Keishiro, Kakehi Kazuyoshi, Fujita Kosuke, Matsumura Koichiro, Nakazawa Gaku
Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
J Intensive Care. 2024 Nov 18;12(1):49. doi: 10.1186/s40560-024-00761-z.
The mortality rate of patients with cardiogenic shock (CS) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with Impella (ECPELLA) support remains high. Inhaled nitric oxide (iNO) improves right ventricular (RV) function, resulting in increased Impella flow, which may facilitate early withdrawal of VA-ECMO and improve survival. This study investigated the prognostic impact of iNO therapy in ECPELLA patients.
We retrospectively analyzed the data of consecutive patients with CS supported by ECPELLA from September 2019 to March 2024 at our hospital. Changes in pulmonary artery pulsatility index (PAPi) and Impella flow over time were evaluated, and VA-ECMO withdrawal rate, time to withdrawal, and 30-day survival were compared between ECPELLA patients with and without iNO therapy.
Of the 48 ECPELLA patients, 25 were treated with iNO. There were no significant differences between the groups in baseline characteristics or lactate levels at mechanical circulatory support induction. Patients with iNO therapy demonstrated significant improvements in the PAPi over time and a trend toward increased Impella flow, as well as a significantly higher VA-ECMO withdrawal rate (88% vs. 48%, P = 0.002) and a shorter time to VA-ECMO withdrawal (5 [3-6] days vs. 7 [6-13] days, P = 0.0008) than those without iNO therapy. Kaplan-Meier analysis demonstrated that the 30-day survival rate was significantly higher in patients with iNO than in those without (76% vs. 26%, P = 0.0002).
iNO therapy in patients with CS requiring ECPELLA was associated with short-term prognosis by improving RV function and facilitating weaning from VA-ECMO. Trial registration Retrospectively registered in UMIN-CTR (Reference No. R00006352).
需要静脉-动脉体外膜肺氧合（VA-ECMO）联合Impella（ECPELLA）支持的心源性休克（CS）患者死亡率仍然很高。吸入一氧化氮（iNO）可改善右心室（RV）功能，使Impella血流量增加，这可能有助于早期撤除VA-ECMO并提高生存率。本研究调查了iNO治疗对接受ECPELLA治疗患者预后的影响。
我们回顾性分析了2019年9月至2024年3月在我院接受ECPELLA支持的连续性CS患者的数据。评估肺动脉搏动指数（PAPi）和Impella血流量随时间的变化，并比较接受和未接受iNO治疗的ECPELLA患者的VA-ECMO撤除率、撤除时间和30天生存率。
48例接受ECPELLA治疗的患者中，25例接受了iNO治疗。两组在机械循环支持开始时的基线特征或乳酸水平无显著差异。接受iNO治疗的患者PAPi随时间显著改善，Impella血流量有增加趋势，VA-ECMO撤除率显著更高（88%对48%，P = 0.002），VA-ECMO撤除时间更短（5[3-6]天对7[6-13]天，P = 0.0008）。Kaplan-Meier分析表明，接受iNO治疗的患者30天生存率显著高于未接受治疗的患者（76%对26%，P = 0.0002）。
需要ECPELLA支持的CS患者接受iNO治疗可通过改善RV功能和促进VA-ECMO撤机与短期预后相关。试验注册在UMIN-CTR中进行回顾性注册（参考编号R00006352）。
