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Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study

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Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. / Schrage, Benedikt; Becher, Peter Moritz; Bernhardt, Alexander; Bezerra, Hiram; Blankenberg, Stefan; Brunner, Stefan; Colson, Pascal; Cudemus Deseda, Gaston; Dabboura, Salim; Eckner, Dennis; Eden, Matthias; Eitel, Ingo; Frank, Derk; Frey, Norbert; Funamoto, Masaki; Goßling, Alina; Graf, Tobias; Hagl, Christian; Kirchhof, Paulus; Kupka, Danny; Landmesser, Ulf; Lipinski, Jerry; Lopes, Mathew; Majunke, Nicolas; Maniuc, Octavian; McGrath, Daniel; Möbius-Winkler, Sven; Morrow, David A; Mourad, Marc; Noel, Curt; Nordbeck, Peter; Orban, Martin; Pappalardo, Federico; Patel, Sandeep M; Pauschinger, Matthias; Pazzanese, Vittorio; Reichenspurner, Hermann; Sandri, Marcus; Schulze, P Christian; H G Schwinger, Robert; Sinning, Jan-Malte; Aksoy, Adem; Skurk, Carsten; Szczanowicz, Lukasz; Thiele, Holger; Tietz, Franziska; Varshney, Anubodh; Wechsler, Lukas; Westermann, Dirk.

In: CIRCULATION, Vol. 142, No. 22, 12.2020, p. 2095-2106.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Schrage, B, Becher, PM, Bernhardt, A, Bezerra, H, Blankenberg, S, Brunner, S, Colson, P, Cudemus Deseda, G, Dabboura, S, Eckner, D, Eden, M, Eitel, I, Frank, D, Frey, N, Funamoto, M, Goßling, A, Graf, T, Hagl, C, Kirchhof, P, Kupka, D, Landmesser, U, Lipinski, J, Lopes, M, Majunke, N, Maniuc, O, McGrath, D, Möbius-Winkler, S, Morrow, DA, Mourad, M, Noel, C, Nordbeck, P, Orban, M, Pappalardo, F, Patel, SM, Pauschinger, M, Pazzanese, V, Reichenspurner, H, Sandri, M, Schulze, PC, H G Schwinger, R, Sinning, J-M, Aksoy, A, Skurk, C, Szczanowicz, L, Thiele, H, Tietz, F, Varshney, A, Wechsler, L & Westermann, D 2020, 'Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study', CIRCULATION, vol. 142, no. 22, pp. 2095-2106. https://doi.org/10.1161/CIRCULATIONAHA.120.048792

APA

Schrage, B., Becher, P. M., Bernhardt, A., Bezerra, H., Blankenberg, S., Brunner, S., Colson, P., Cudemus Deseda, G., Dabboura, S., Eckner, D., Eden, M., Eitel, I., Frank, D., Frey, N., Funamoto, M., Goßling, A., Graf, T., Hagl, C., Kirchhof, P., ... Westermann, D. (2020). Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. CIRCULATION, 142(22), 2095-2106. https://doi.org/10.1161/CIRCULATIONAHA.120.048792

Vancouver

Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S et al. Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. CIRCULATION. 2020 Dec;142(22):2095-2106. https://doi.org/10.1161/CIRCULATIONAHA.120.048792

Bibtex

@article{81a9798ed9754dbdb9b0449b7efa9854,
title = "Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study",
abstract = "BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.METHODS: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort.RESULTS: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%).CONCLUSIONS: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.",
keywords = "Adult, Aged, Cohort Studies, Extracorporeal Membrane Oxygenation/mortality, Female, Humans, Internationality, Male, Middle Aged, Mortality/trends, Shock, Cardiogenic/diagnosis, Treatment Outcome, Ventricular Function, Left/physiology",
author = "Benedikt Schrage and Becher, {Peter Moritz} and Alexander Bernhardt and Hiram Bezerra and Stefan Blankenberg and Stefan Brunner and Pascal Colson and {Cudemus Deseda}, Gaston and Salim Dabboura and Dennis Eckner and Matthias Eden and Ingo Eitel and Derk Frank and Norbert Frey and Masaki Funamoto and Alina Go{\ss}ling and Tobias Graf and Christian Hagl and Paulus Kirchhof and Danny Kupka and Ulf Landmesser and Jerry Lipinski and Mathew Lopes and Nicolas Majunke and Octavian Maniuc and Daniel McGrath and Sven M{\"o}bius-Winkler and Morrow, {David A} and Marc Mourad and Curt Noel and Peter Nordbeck and Martin Orban and Federico Pappalardo and Patel, {Sandeep M} and Matthias Pauschinger and Vittorio Pazzanese and Hermann Reichenspurner and Marcus Sandri and Schulze, {P Christian} and {H G Schwinger}, Robert and Jan-Malte Sinning and Adem Aksoy and Carsten Skurk and Lukasz Szczanowicz and Holger Thiele and Franziska Tietz and Anubodh Varshney and Lukas Wechsler and Dirk Westermann",
year = "2020",
month = dec,
doi = "10.1161/CIRCULATIONAHA.120.048792",
language = "English",
volume = "142",
pages = "2095--2106",
journal = "CIRCULATION",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

RIS

TY - JOUR

T1 - Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study

AU - Schrage, Benedikt

AU - Becher, Peter Moritz

AU - Bernhardt, Alexander

AU - Bezerra, Hiram

AU - Blankenberg, Stefan

AU - Brunner, Stefan

AU - Colson, Pascal

AU - Cudemus Deseda, Gaston

AU - Dabboura, Salim

AU - Eckner, Dennis

AU - Eden, Matthias

AU - Eitel, Ingo

AU - Frank, Derk

AU - Frey, Norbert

AU - Funamoto, Masaki

AU - Goßling, Alina

AU - Graf, Tobias

AU - Hagl, Christian

AU - Kirchhof, Paulus

AU - Kupka, Danny

AU - Landmesser, Ulf

AU - Lipinski, Jerry

AU - Lopes, Mathew

AU - Majunke, Nicolas

AU - Maniuc, Octavian

AU - McGrath, Daniel

AU - Möbius-Winkler, Sven

AU - Morrow, David A

AU - Mourad, Marc

AU - Noel, Curt

AU - Nordbeck, Peter

AU - Orban, Martin

AU - Pappalardo, Federico

AU - Patel, Sandeep M

AU - Pauschinger, Matthias

AU - Pazzanese, Vittorio

AU - Reichenspurner, Hermann

AU - Sandri, Marcus

AU - Schulze, P Christian

AU - H G Schwinger, Robert

AU - Sinning, Jan-Malte

AU - Aksoy, Adem

AU - Skurk, Carsten

AU - Szczanowicz, Lukasz

AU - Thiele, Holger

AU - Tietz, Franziska

AU - Varshney, Anubodh

AU - Wechsler, Lukas

AU - Westermann, Dirk

PY - 2020/12

Y1 - 2020/12

N2 - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.METHODS: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort.RESULTS: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%).CONCLUSIONS: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.

AB - BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.METHODS: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort.RESULTS: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%).CONCLUSIONS: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.

KW - Adult

KW - Aged

KW - Cohort Studies

KW - Extracorporeal Membrane Oxygenation/mortality

KW - Female

KW - Humans

KW - Internationality

KW - Male

KW - Middle Aged

KW - Mortality/trends

KW - Shock, Cardiogenic/diagnosis

KW - Treatment Outcome

KW - Ventricular Function, Left/physiology

U2 - 10.1161/CIRCULATIONAHA.120.048792

DO - 10.1161/CIRCULATIONAHA.120.048792

M3 - SCORING: Journal article

C2 - 33032450

VL - 142

SP - 2095

EP - 2106

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 22

ER -