Jaime Hernandez-Montfort, Kevin J John, Daniel Goldstein, Roberto Lorusso, Shashank S Sinha, Rachel Goodman, Peter Natov, Song Li, Borui Li, Manreet Kanwar, Arthur Reshad Garan, Jacob Abraham, Qiuyue Kong, Paavni Sangal, Karol Walec, Claudius Mahr, Aniket Rali, Daniel Burkhoff, Navin K Kapur
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Group comparisons used the Student's t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.</p><p><strong>Results: </strong>Between 2019 and 2023, 1,728 out of 11,244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p < 0.01). Heart replacement therapy was more common among HF-CS patients (24% vs 7%, HF vs MI-CS, p < 0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (14% overall, 10% vs 17%, HF vs MI-CS, p < 0.01), bleeding (53% overall, 47% vs 56%, HF vs MI-CS, p < 0.01), and stroke (13% overall, 10% vs 16%, HF vs MI-CS, p < 0.01).</p><p><strong>Conclusions: </strong>Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO. These findings may inform future shock trial designs.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical outcomes of cardiogenic shock patients supported with VA-ECMO: Insights from the Cardiogenic Shock Working Group.\",\"authors\":\"Jaime Hernandez-Montfort, Kevin J John, Daniel Goldstein, Roberto Lorusso, Shashank S Sinha, Rachel Goodman, Peter Natov, Song Li, Borui Li, Manreet Kanwar, Arthur Reshad Garan, Jacob Abraham, Qiuyue Kong, Paavni Sangal, Karol Walec, Claudius Mahr, Aniket Rali, Daniel Burkhoff, Navin K Kapur\",\"doi\":\"10.1016/j.healun.2025.07.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for cardiogenic shock (CS) is increasing worldwide despite conflicting results from randomized trials, which focused on myocardial infarction-related CS (MI-CS).</p><p><strong>Methods: </strong>We performed a retrospective analysis of the Cardiogenic Shock Working Group multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions. Group comparisons used the Student's t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.</p><p><strong>Results: </strong>Between 2019 and 2023, 1,728 out of 11,244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p < 0.01). Heart replacement therapy was more common among HF-CS patients (24% vs 7%, HF vs MI-CS, p < 0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (14% overall, 10% vs 17%, HF vs MI-CS, p < 0.01), bleeding (53% overall, 47% vs 56%, HF vs MI-CS, p < 0.01), and stroke (13% overall, 10% vs 16%, HF vs MI-CS, p < 0.01).</p><p><strong>Conclusions: </strong>Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO. 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引用次数: 0
摘要
背景:静脉-动脉体外膜氧合(VA-ECMO)用于心源性休克(CS)在世界范围内正在增加,尽管随机试验的结果相互矛盾,这些试验主要集中在心肌梗死相关的CS (MI-CS)。方法:我们对心源性休克工作组(CSWG)多中心注册表进行了回顾性分析,以评估VA-ECMO支持下CS的结果。对于正态/非正态分布,连续变量以平均值±SD或中位数+IQR表示。组间比较对正态/非正态数据使用t检验或Mann-Whitney U检验,对比例使用卡方检验。结果:2019年至2023年,11244例CS患者中有1728例(15.3%)接受了VA-ECMO。中位年龄为58岁,69.9%为男性。休克的病因是心力衰竭(HF-CS: 45%)、心肌梗死(MI-CS;34%),其他cs(22%)。MI- cs的死亡率为51%甚至更高(60% vs 42%, MI vs HF-CS,住院期间使用MCS装置)。并发症包括急性肢体缺血(ALI:总体为14%,10% vs 17%, HF vs MI-CS)。结论:使用大型当代现实CS登记,我们报告了VA-ECMO的高死亡率和并发症发生率,并进一步确定了MI-CS和HF-CS之间的结果显着差异。这些发现可能为临床实践、新设备开发和未来的休克试验设计提供信息。
Clinical outcomes of cardiogenic shock patients supported with VA-ECMO: Insights from the Cardiogenic Shock Working Group.
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for cardiogenic shock (CS) is increasing worldwide despite conflicting results from randomized trials, which focused on myocardial infarction-related CS (MI-CS).
Methods: We performed a retrospective analysis of the Cardiogenic Shock Working Group multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions. Group comparisons used the Student's t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.
Results: Between 2019 and 2023, 1,728 out of 11,244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p < 0.01). Heart replacement therapy was more common among HF-CS patients (24% vs 7%, HF vs MI-CS, p < 0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (14% overall, 10% vs 17%, HF vs MI-CS, p < 0.01), bleeding (53% overall, 47% vs 56%, HF vs MI-CS, p < 0.01), and stroke (13% overall, 10% vs 16%, HF vs MI-CS, p < 0.01).
Conclusions: Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO. These findings may inform future shock trial designs.
期刊介绍:
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.