Mechanical Left Ventricular Unloading in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.
J Am Coll Cardiol
; 79(13): 1239-1250, 2022 04 05.
Article
em En
| MEDLINE
| ID: mdl-35361346
ABSTRACT
BACKGROUND:
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases left ventricular (LV) afterload, potentially provoking LV distention and impairing recovery. LV mechanical unloading (MU) with intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD) can prevent LV distension, potentially at the risk of more complications, and net clinical benefit remains uncertain.OBJECTIVES:
This study aims to determine the association between MU and outcomes for patients undergoing VA-ECMO.METHODS:
The authors queried the Extracorporeal Life Support Organization registry for adults receiving peripheral VA-ECMO from 2010 to 2019 and stratified them by MU with IABP or pVAD. The primary outcome was in-hospital mortality; secondary outcomes included on-support mortality and complications during VA-ECMO.RESULTS:
Among 12,734 VA-ECMO patients, 3,399 (26.7%) received MU 2,782 (82.9%) IABP and 580 (17.1%) pVAD. MU patients were older (age 56.3 vs 52.7 years) and, before extracorporeal membrane oxygenation, more often required >2 vasopressors (41.7% vs 27.2%) and had respiratory (21.1% vs 15.9%), renal (24.6% vs 15.8%), and liver failure (4.4% vs 3.1%) (all P < 0.001). MU patients had lower in-hospital mortality (56.6% vs 59.3%, P = 0.006), which persisted in multivariable modeling (adjusted OR [aOR] 0.84; 95% CI 0.77-0.92; P < 0.001). MU was associated with more cannula site bleeding (aOR 1.25; 95% CI 1.11-1.40; P < 0.001) and hemolysis (aOR 1.27; 95% CI 1.03-1.57; P = 0.02). Compared to pVAD, MU patients with IABP had similar mortality (aOR 0.80; 95% CI 0.64-1.01; P = 0.06) and less medical bleeding (aOR 0.45; 95% CI 0.31-0.64; P < 0.001), cannula site bleeding (aOR 0.72; 95% CI 0.54-0.96; P = 0.03), and renal injury (aOR 0.78; 95% CI 0.62-0.98; P = 0.03).CONCLUSIONS:
Among adults receiving VA-ECMO, MU was associated with lower in-hospital mortality despite increased complications including hemolysis and cannulation site bleeding. Compared to pVAD, MU with IABP was associated with similar mortality and lower complication rates.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
/
Coração Auxiliar
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article