TY - JOUR
T1 - Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock
AU - Montero, Santiago
AU - Huang, Florent
AU - Rivas-Lasarte, Mercedes
AU - Chommeloux, Juliette
AU - Demondion, Pierre
AU - Bréchot, Nicolas
AU - Hékimian, Guillaume
AU - Franchineau, Guillaume
AU - Persichini, Romain
AU - Luyt, Charles Édouard
AU - Garcia-Garcia, Cosme
AU - Bayes-Genis, Antoni
AU - Lebreton, Guillaume
AU - Cinca, Juan
AU - Leprince, Pascal
AU - Combes, Alain
AU - Alvarez-Garcia, Jesus
AU - Schmidt, Matthieu
N1 - Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is currently one of the first-line therapies for refractory cardiogenic shock (CS), but its applicability is undermined by the high morbidity associated with its complications, especially those related to mechanical ventilation (MV). We aimed to assess the prognostic impact of keeping patients in refractory CS awake at cannulation and during the VA-ECMO run. Methods: A 7-year database of patients given peripheral VA-ECMO support was used to conduct a propensity-score (PS)-matched analysis to balance their clinical profiles. Patients were classified as 'awake ECMO' or 'non-awake ECMO', respectively, if invasive MV was used during ≤50% or >50% of the VA-ECMO run. Primary outcomes included ventilator-associated pneumonia and ECMO-related complication rates, and secondary outcomes were 60-day and 1-year mortality. A multivariate logistic-regression analysis was used to identify whether MV at cannulation was independently associated with 60-day mortality. Results: Among 231 patients included, 91 (39%) were 'awake' and 140 (61%) 'non-awake'. After PS-matching adjustment, the 'awake ECMO' group had significantly lower rates of pneumonia (35% vs. 59%, P = 0.017), tracheostomy, renal replacement therapy, and less antibiotic and sedative consumption. This strategy was also associated with reduced 60-day (20% vs. 41%, P = 0.018) and 1-year mortality rates (31% vs. 54%, P = 0.021) compared to the 'non-awake' group, respectively. Lastly, MV at ECMO cannulation was independently associated with 60-day mortality. Conclusion: An 'awake ECMO' management in VA-ECMO-supported CS patients is feasible, safe, and associated with improved short- A nd long-term outcomes.
AB - Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is currently one of the first-line therapies for refractory cardiogenic shock (CS), but its applicability is undermined by the high morbidity associated with its complications, especially those related to mechanical ventilation (MV). We aimed to assess the prognostic impact of keeping patients in refractory CS awake at cannulation and during the VA-ECMO run. Methods: A 7-year database of patients given peripheral VA-ECMO support was used to conduct a propensity-score (PS)-matched analysis to balance their clinical profiles. Patients were classified as 'awake ECMO' or 'non-awake ECMO', respectively, if invasive MV was used during ≤50% or >50% of the VA-ECMO run. Primary outcomes included ventilator-associated pneumonia and ECMO-related complication rates, and secondary outcomes were 60-day and 1-year mortality. A multivariate logistic-regression analysis was used to identify whether MV at cannulation was independently associated with 60-day mortality. Results: Among 231 patients included, 91 (39%) were 'awake' and 140 (61%) 'non-awake'. After PS-matching adjustment, the 'awake ECMO' group had significantly lower rates of pneumonia (35% vs. 59%, P = 0.017), tracheostomy, renal replacement therapy, and less antibiotic and sedative consumption. This strategy was also associated with reduced 60-day (20% vs. 41%, P = 0.018) and 1-year mortality rates (31% vs. 54%, P = 0.021) compared to the 'non-awake' group, respectively. Lastly, MV at ECMO cannulation was independently associated with 60-day mortality. Conclusion: An 'awake ECMO' management in VA-ECMO-supported CS patients is feasible, safe, and associated with improved short- A nd long-term outcomes.
KW - Awake ECMO
KW - Cardiogenic shock
KW - Extracorporeal membrane oxygenation
KW - Mechanical ventilation
KW - Outcome
KW - Propensity score
KW - Awake ECMO
KW - Cardiogenic shock
KW - Extracorporeal membrane oxygenation
KW - Outcome
KW - Mechanical ventilation
KW - Propensity score
KW - Awake ECMO
KW - Cardiogenic shock
KW - Extracorporeal membrane oxygenation
KW - Outcome
KW - Mechanical ventilation
KW - Propensity score
UR - http://www.scopus.com/inward/record.url?scp=85105906732&partnerID=8YFLogxK
U2 - 10.1093/ehjacc/zuab018
DO - 10.1093/ehjacc/zuab018
M3 - Article
C2 - 33822901
AN - SCOPUS:85105906732
SN - 2048-8726
VL - 10
SP - 585
EP - 594
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 6
ER -