Prognosis of refractory cardiogenic shock in de-novo versus acute-on-chronic heart failure: Insights from the HYPO-ECMO trial

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-02-28 DOI:10.1016/j.jcrc.2025.155043

Guillaume Baudry , Bruno Levy , Kevin Duarte , Luca Monzo , Alain Combes , Antoine Kimmoun , Nicolas Girerd

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Abstract

Background

Acute-on-chronic heart failure (ACHF) currently represents the leading etiology of cardiogenic shock (CS). We aimed to assess the prognostic value of history of heart failure (HF) in patients with refractory CS as well as its effect on the benefit of moderate hypothermia (MH) (33–34 °C).

Methods

Of the 334 patients included in the HYPO-ECMO trial, 321 (96 %) had available HF history information, among whom 65 (20 %) had prior HF. Inverse probability weighting (IPW) was used to compare ACHF patients and de-novo HF (DNHF) patients. Primary outcome was all-cause mortality at day 30. Main secondary outcomes were mortality and the composite of death, heart transplant, escalation to left ventricular assist device, or stroke up to day 180.

Results

At 30 days, 26 patients (40.0 %) died in the ACHF group versus 122 patients (47.7 %) in the DNHF group (crude risk difference (RD), −7.7 % [−21.0 to 5.7] p = 0.26; IPW RD, −11.6 % [−24.8 to 1.6] p = 0.084). Mortality (IPW RD, −13.7 % [−27.1 to −0.2], p = 0.047) and the composite outcome (IPW RD, −19.5 % [−32.9 to −6.1], p = 0.004) were significantly lower at day 180 in the ACHF group. Patients randomized to MH tended to have a lower risk for the primary outcome (RD -10.9 %, [−23.1 to 1.2], p = 0.078) and a significant reduction in composite outcome (p < 0.05 at each timepoint) in the DNHF group but not in the ACHF group, despite the absence of a significant interaction (p > 0.05).

Conclusions

In VA-ECMO-treated CS, ACHF was associated with comparable 30-day survival but lower 180-day mortality and morbidity-mortality. In this exploratory post-hoc analysis, MH appeared to be associated with improved outcomes in DNHF patients only.

ClinicalTrials.gov Identifier: NCT02754193

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.