Effect of extracorporeal membrane oxygenation combined with hemoperfusion on inflammatory factors in patients with cardiogenic shock.

Abstract

Background: Data on adsorptive extracorporeal membrane oxygenation (ECMO) (combined with HA380 hemoperfusion column) on the inflammatory factors in patients with cardiogenic shock (CS) remains limited.

Aim: To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.

Methods: A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction, fulminant myocarditis, or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024. Patients were divided into the conventional ECMO group (42 cases) and the adsorptive ECMO group (ECMO combined with hemoperfusion, 39 cases). The adsorptive ECMO group received 2 columns of HA380 initiation on the first day (the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO), followed by 1 column each day, with each column used for 4-6 hours, totaling 24-30 hours of treatment. Baseline data were compared between the two groups: Inflammatory factor levels (at 0, 6, 12, 24, 48, and 72 hours after ECMO or hemoperfusion initiation); ECMO support duration; successful weaning rate; continuous renal replacement therapy (CRRT) utilization; Sequential Organ Failure Assessment (SOFA) score; Vasoactive-Inotropic Score (VIS); systemic inflammatory response syndrome (SIRS) incidence; and in-hospital survival and 30-/90-day survival after discharge.

Results: The adsorptive ECMO group showed significantly lower levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and lactate from 6 to 72 hours compared with the conventional ECMO group (all P < 0.05), with IL-6 decreasing by 94.4% and tumour necrosis factor alpha by 70.1% from baseline at 72 hours. The adsorptive ECMO group had a significantly shorter ECMO duration [114.0 (75.0-139.0) hours vs 135.0 (73.0-199.3) hours, P = 0.032]; higher successful weaning rate (66.7% vs 42.9%, P = 0.032); a trend toward lower CRRT utilization (54.8% vs 38.5%, P = 0.070); lower post-weaning SOFA score [7 (6-8) vs 9 (8-10), P < 0.001]; significantly reduced VIS (8.4 ± 1.3 vs 9.8 ± 1.6, P < 0.001); and a trend toward lower SIRS incidence (10.3% vs 26.2%, P = 0.065). There were no significant differences in complications, in-hospital survival (64.1% vs 52.4%, P = 0.285); or 30-/90-day survival between the two groups (all P > 0.05).

Conclusion: Adsorptive ECMO efficiently clears IL-6 and TNF-α, significantly improving ECMO weaning success rate and hemodynamics. However, it has no significant impact on survival, and its efficacy requires validation through prospective studies.