Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock

Santiago Montero, Florent Huang, Mercedes Rivas-Lasarte, Juliette Chommeloux, Pierre Demondion, Nicolas Bréchot, Guillaume Hékimian, Guillaume Franchineau, Romain Persichini, Charles Édouard Luyt, Cosme Garcia-Garcia, Antoni Bayes-Genis, Guillaume Lebreton, Juan Cinca, Pascal Leprince, Alain Combes, Jesus Alvarez-Garcia, Matthieu Schmidt*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

30 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)585-594
Number of pages10
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume10
Issue number6
DOIs
Publication statusPublished - 1 Aug 2021

Keywords

  • Awake ECMO
  • Cardiogenic shock
  • Extracorporeal membrane oxygenation
  • Mechanical ventilation
  • Outcome
  • Propensity score

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