Lanmüller Pia, Hinrichs Nils, Nersesian Gaik, Lewin Daniel, O'Brien Ben, Falk Volkmar, Potapov Evgenij, Starck Christoph, Ott Sascha
From the Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
ASAIO J. 2025 Jul 1;71(7):536-543. doi: 10.1097/MAT.0000000000002364. Epub 2024 Dec 18.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is applied for the treatment of cardiogenic shock. Concomitant left ventricular unloading (LVU) with a microaxial flow pump (mAFP) enables myocardial and pulmonary recovery and may overcome some of the limitations of VA-ECMO. The study included 145 cardiogenic shock patients, 89 (61.4%) of whom were treated with VA-ECMO alone (ECMO group), whereas 56 (38.6%) received LVU with a surgically implanted mAFP on top of VA-ECMO (ECMELLA group). After 2:1 propensity score matching, 30 day and 1 year survival was similar between the groups ( p = 0.62 and 0.68, respectively). In the subgroup analysis, patients who received mAFP in the first 2 hours after VA-ECMO implantation had an improved 30 day (hazard ratio [HR]: 0.45 [95% confidence interval {CI}: 0.23-0.88], p = 0.02) and 1 year survival (HR: 0.52 [95% CI: 0.28-0.97], p = 0.04). The rate of limb ischemia, hemorrhage, and renal replacement therapy were comparable between the propensity score-matched cohorts. Early LVU with a surgically implanted mAFP in patients on VA-ECMO improved short-and long-term survival.
静脉-动脉体外膜肺氧合（VA-ECMO）用于治疗心源性休克。使用微型轴流泵（mAFP）进行左心室卸载（LVU）可促进心肌和肺功能恢复，并可能克服VA-ECMO的一些局限性。该研究纳入了145例心源性休克患者，其中89例（61.4%）仅接受VA-ECMO治疗（ECMO组），而56例（38.6%）在VA-ECMO基础上接受了手术植入mAFP的LVU治疗（ECMELLA组）。经过2:1倾向评分匹配后，两组的30天和1年生存率相似（p分别为0.62和0.68）。在亚组分析中，在VA-ECMO植入后2小时内接受mAFP治疗的患者30天生存率有所提高（风险比[HR]：0.45[95%置信区间{CI}：0.23-0.88]，p = 0.02），1年生存率也有所提高（HR：0.52[95%CI：0.28-0.97]，p = 0.04）。倾向评分匹配队列之间的肢体缺血、出血和肾脏替代治疗发生率相当。在接受VA-ECMO治疗的患者中，早期使用手术植入的mAFP进行LVU可改善短期和长期生存率。
