Liangshan Wang, Kexin Wang, Yan Wang, Feng Yang, Chenglong Li, Xing Hao, Zhongtao Du, Peter T Rycus, Joseph E Tonna, Eddy Fan, Hong Wang, Xiaotong Hou
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The bundle included mean arterial pressure > 65 mmHg, PaO<sub>2</sub> 60-150 mmHg, relative change in PaCO<sub>2</sub> [RelΔCO<sub>2</sub>] > -50% (RelΔCO<sub>2</sub> = [(PaCO<sub>2-24hours</sub>-PaCO<sub>2-baseline</sub>)/PaCO<sub>2-baseline</sub>] ∗ 100%), and peak inspiratory pressure < 30 mmHg. The primary outcome was survival to hospital discharge, while secondary outcomes were complications.</p><p><strong>Findings: </strong>Of 7950 patients (mean age 56.5 ± 14.3 years), 2762 (34.7%) received the complete bundle. The bundle group had significantly higher rates of survival to hospital discharge (55.9% vs. 39.4%, <i>p</i> < 0.001) with adjusted odds ratio [aOR] of 1.849 (95% CI [1.675, 2.042]; <i>p</i> < 0.001), and the likelihood of brain death (aOR = 0.521, 95% CI: 0.289-0.885; <i>p</i> = 0.021), ischemic stroke (aOR = 0.710, 95% CI: 0.559-0.896; <i>p</i> = 0.004), hemorrhagic complications (aOR = 0.773, 95% CI: 0.681-0.876; <i>p</i> < 0.001) and cardiovascular complications (aOR = 0.863, 95% CI: 0.770-0.966; <i>p</i> = 0.011) were reduced.</p><p><strong>Interpretation: </strong>Achieving the proposed physiologic bundle is associated with improved survival and a reduced risk of complications in VA-ECMO patients with CS. These findings provide evidence supporting the use of standardized care bundles in the management of VA-ECMO patients with CS.</p><p><strong>Funding: </strong>This work was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZYLX202111, to X Hou), Beijing Hospitals Authority \"Ascent Plan\" (No. FDL20190601, to X Hou), Young Elite Scientists Sponsorship Program by CAST (No. 2022QNRC001, to L Wang), National Natural Science Foundation of China (No. 82200433, to L Wang), and Beijing Hospitals Authority Youth Programme (No. QML20230602, to L Wang), National Natural Science Foundation of China (No. 82100408, to X Hao), Beijing Nova Program (No. 2022064, to C Li), Beijing Natural Science Foundation (No. 7244327, to C Li), and the National Key Research and Development Program of China (No. 2021YFC2701700 and 2021YFC2701703, to Z Du).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"87 ","pages":"103423"},"PeriodicalIF":10.0000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355413/pdf/","citationCount":"0","resultStr":"{\"title\":\"A simple VA-ECMO bundle in adult patients with cardiogenic shock: an analysis of ELSO registry.\",\"authors\":\"Liangshan Wang, Kexin Wang, Yan Wang, Feng Yang, Chenglong Li, Xing Hao, Zhongtao Du, Peter T Rycus, Joseph E Tonna, Eddy Fan, Hong Wang, Xiaotong Hou\",\"doi\":\"10.1016/j.eclinm.2025.103423\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The optimal management strategy for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) remains uncertain. 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The bundle group had significantly higher rates of survival to hospital discharge (55.9% vs. 39.4%, <i>p</i> < 0.001) with adjusted odds ratio [aOR] of 1.849 (95% CI [1.675, 2.042]; <i>p</i> < 0.001), and the likelihood of brain death (aOR = 0.521, 95% CI: 0.289-0.885; <i>p</i> = 0.021), ischemic stroke (aOR = 0.710, 95% CI: 0.559-0.896; <i>p</i> = 0.004), hemorrhagic complications (aOR = 0.773, 95% CI: 0.681-0.876; <i>p</i> < 0.001) and cardiovascular complications (aOR = 0.863, 95% CI: 0.770-0.966; <i>p</i> = 0.011) were reduced.</p><p><strong>Interpretation: </strong>Achieving the proposed physiologic bundle is associated with improved survival and a reduced risk of complications in VA-ECMO patients with CS. 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引用次数: 0
摘要
背景：对接受静脉-动脉体外膜氧合（VA-ECMO）治疗心源性休克（CS）的患者的最佳管理策略仍不确定。评估“捆绑”生理靶点对VA-ECMO患者预后的影响。方法：这项回顾性队列研究分析了体外生命支持组织（ELSO）登记的数据，包括2013年至2022年间接受VA-ECMO治疗CS的成年患者。根据患者是否在前24小时内接受全套束成分分组。束包括平均动脉压> 65 mmHg, PaO2 60-150 mmHg, PaCO2 [RelΔCO2] > -50% (RelΔCO2 = [（PaCO2-24小时-PaCO2-基线）/PaCO2-基线]∗100%)，以及峰值吸气压< 30 mmHg。主要结局是存活至出院，次要结局是并发症。结果：7950例患者（平均年龄56.5±14.3岁）中，2762例（34.7%）接受了完整的治疗。包组有显著较高的生存出院(55.9%比39.4%,p < 0.001)调整优势比(aOR)为1.849(95%可信区间(1.675,2.042);p < 0.001),脑死亡的可能性(优势比= 0.521,95% CI: 0.289—-0.885;p = 0.021),缺血性中风(优势比= 0.710,95% CI: 0.559—-0.896;p = 0.004),出血性并发症(优势比= 0.773,95% CI: 0.681—-0.876;p < 0.001)和心血管并发症(优势比= 0.863,95% CI: 0.770—-0.966;p = 0.011)减少。解释：在VA-ECMO合并CS的患者中，实现拟议的生理束与提高生存率和降低并发症风险相关。这些发现提供了支持在VA-ECMO合并CS患者的管理中使用标准化护理包的证据。资助：本工作由北京市医院管理局临床医学发展专项资金支持(No。ZYLX202111，至X侯)，北京医院管理局“上升计划”（编号：ZYLX202111）；中国科协青年精英科学家资助计划（No. 2022QNRC001，资助王丽丽），国家自然科学基金（No. 82200433，资助王丽丽），北京医院管理局青年计划（No. 82200433，资助王丽丽）；国家自然科学基金项目（No. 82100408），北京市新星计划项目（No. 2022064, to Li C），北京市自然科学基金项目（No. 7244327, to Li C），国家重点研发计划项目（No. 2021YFC2701700, 2021YFC2701703, to Du Z）。
A simple VA-ECMO bundle in adult patients with cardiogenic shock: an analysis of ELSO registry.
Background: The optimal management strategy for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) remains uncertain. To evaluate the impact of "bundled" physiologic targets on outcomes in VA-ECMO patients.
Methods: This retrospective cohort study analyzed data from the Extracorporeal Life Support Organization (ELSO) registry, including adult patients receiving VA-ECMO for CS between 2013 and 2022. Patients were grouped by whether they received the full set of bundle components within the first 24 h. The bundle included mean arterial pressure > 65 mmHg, PaO2 60-150 mmHg, relative change in PaCO2 [RelΔCO2] > -50% (RelΔCO2 = [(PaCO2-24hours-PaCO2-baseline)/PaCO2-baseline] ∗ 100%), and peak inspiratory pressure < 30 mmHg. The primary outcome was survival to hospital discharge, while secondary outcomes were complications.
Findings: Of 7950 patients (mean age 56.5 ± 14.3 years), 2762 (34.7%) received the complete bundle. The bundle group had significantly higher rates of survival to hospital discharge (55.9% vs. 39.4%, p < 0.001) with adjusted odds ratio [aOR] of 1.849 (95% CI [1.675, 2.042]; p < 0.001), and the likelihood of brain death (aOR = 0.521, 95% CI: 0.289-0.885; p = 0.021), ischemic stroke (aOR = 0.710, 95% CI: 0.559-0.896; p = 0.004), hemorrhagic complications (aOR = 0.773, 95% CI: 0.681-0.876; p < 0.001) and cardiovascular complications (aOR = 0.863, 95% CI: 0.770-0.966; p = 0.011) were reduced.
Interpretation: Achieving the proposed physiologic bundle is associated with improved survival and a reduced risk of complications in VA-ECMO patients with CS. These findings provide evidence supporting the use of standardized care bundles in the management of VA-ECMO patients with CS.
Funding: This work was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZYLX202111, to X Hou), Beijing Hospitals Authority "Ascent Plan" (No. FDL20190601, to X Hou), Young Elite Scientists Sponsorship Program by CAST (No. 2022QNRC001, to L Wang), National Natural Science Foundation of China (No. 82200433, to L Wang), and Beijing Hospitals Authority Youth Programme (No. QML20230602, to L Wang), National Natural Science Foundation of China (No. 82100408, to X Hao), Beijing Nova Program (No. 2022064, to C Li), Beijing Natural Science Foundation (No. 7244327, to C Li), and the National Key Research and Development Program of China (No. 2021YFC2701700 and 2021YFC2701703, to Z Du).
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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