Peripheral-to-central extracorporeal corporeal membrane oxygenation switch in refractory cardiogenic shock patients: outcomes and bridging strategies.

IF 5.7 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2024-10-07 DOI:10.1186/s13613-024-01382-3

Aurélie Besnard, Quentin Moyon, Guillaume Lebreton, Pierre Demondion, Guillaume Hékimian, Juliette Chommeloux, Matthieu Petit, Melchior Gautier, Lucie Lefevre, Ouriel Saura, David Levy, Matthieu Schmidt, Pascal Leprince, Charles-Edouard Luyt, Alain Combes, Marc Pineton de Chambrun

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引用次数: 0

Abstract

Background: Peripheral veno-arterial extracorporeal membrane oxygenation (pECMO) has become the first-line device in refractory cardiogenic shock (rCS). Some pECMO complications can preclude any bridging strategies and a peripheral-to-central ECMO (cECMO) switch can be considered as a bridge-to-decision. We conducted this study to appraise the in-hospital survival and the bridging strategies in patients undergoing peripheral-to-central ECMO switch.

Methods: This retrospective monocenter study included patients admitted to a ECMO-dedicated intensive care unit from February 2006 to January 2023. Patients with rCS requiring pECMO switched to cECMO were included. Patients were not included when the cECMO was the first mechanical circulatory support.

Results: Eighty patients, with a median [IQR25-75] age of 44 [29-53] years at admission and a female-to-male sex ratio of 0.6 were included in the study. Refractory pulmonary edema was the main switching reason. Thirty patients (38%) were successfully bridged to: heart transplantation (n = 16/80, 20%), recovery (n = 10/80, 12%) and ventricle assist device (VAD, n = 4/30, 5%) while the others died on cECMO (n = 50/80, 62%). The most frequent complications were the need for renal replacement therapy (76%), hemothorax or tamponade (48%), need for surgical revision (34%), mediastinitis (28%), and stroke (28%). The in-hospital and one-year survival rates were 31% and 27% respectively. Myocardial infarction as the cause of the rCS was the only variable independently associated with in-hospital mortality (HR 2.5 [1.3-4.9], p = 0.009).

Conclusions: The switch from a failing pECMO support to a cECMO as a bridge-to-decision is a possible strategy for a very selected population of young patients with a realistic chance of heart function recovery or heart transplantation. In this setting, cECMO allows patients triage preventing from wasting expensive and limited resources.

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难治性心源性休克患者从外周到中央的体外膜氧合转换：结果和桥接策略。

背景：外周静脉-动脉体外膜肺氧合（pECMO）已成为治疗难治性心源性休克（rCS）的一线设备。一些 pECMO 并发症可能导致无法采取任何桥接策略，而外周-中心 ECMO（cECMO）转换可被视为一种桥接决策。我们开展了这项研究，以评估接受外周-中心 ECMO 转换的患者的院内存活率和桥接策略：这项回顾性单中心研究纳入了 2006 年 2 月至 2023 年 1 月期间入住 ECMO 专用重症监护病房的患者。研究纳入了需要 pECMO 转为 cECMO 的 rCS 患者。如果 cECMO 是第一种机械循环支持，则不纳入患者：研究共纳入了 80 名患者，入院时的中位年龄为 44 [IQR25-75] 岁 [29-53]，男女性别比为 0.6。难治性肺水肿是换药的主要原因。30名患者（38%）成功转入：心脏移植（16/80，20%）、康复（10/80，12%）和心室辅助装置（VAD，4/30，5%），其他患者则死于cECMO（50/80，62%）。最常见的并发症是需要肾脏替代疗法（76%）、血胸或血塞（48%）、需要手术翻修（34%）、纵隔炎（28%）和中风（28%）。院内存活率和一年存活率分别为 31% 和 27%。心肌梗死是导致急性心肌梗死的唯一一个与院内死亡率独立相关的变量（HR 2.5 [1.3-4.9]，P = 0.009）：结论：对于极少数有机会恢复心脏功能或接受心脏移植手术的年轻患者来说，将衰竭的 pECMO 支持转为 cECMO 作为决定的桥梁是一种可行的策略。在这种情况下，cECMO 可以对患者进行分流，避免浪费昂贵而有限的资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.