TY - JOUR
T1 - Complications in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy
T2 - distribution and relevance. Results from an international, multicentre cohort study
AU - Beer, Benedikt N
AU - Kellner, Caroline
AU - Goßling, Alina
AU - Sundermeyer, Jonas
AU - Besch, Lisa
AU - Dettling, Angela
AU - Kirchhof, Paulus
AU - Blankenberg, Stefan
AU - Bernhardt, Alexander M
AU - Brunner, Stefan
AU - Colson, Pascal
AU - Eckner, Dennis
AU - Frank, Derk
AU - Eitel, Ingo
AU - Frey, Norbert
AU - Eden, Matthias
AU - Graf, Tobias
AU - Kupka, Danny
AU - Landmesser, Ulf
AU - Majunke, Nicolas
AU - Maniuc, Octavian
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 - Reichenspurner, Hermann
AU - Schulze, P Christian
AU - Schwinger, Robert H G
AU - Wechsler, Antonia
AU - Skurk, Carsten
AU - Thiele, Holger
AU - Varshney, Anubodh S
AU - Sag, Can Martin
AU - Krais, Jannis
AU - Westermann, Dirk
AU - Schrage, Benedikt
N1 - Ecker, Pauschinger: Department of Cardiology, Paracelsus Medical University Nürnberg, Germany
PY - 2023/10/24
Y1 - 2023/10/24
N2 - BACKGROUND: VA-ECMO restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications.OBJECTIVES: To quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (CPC 1 + 2).METHODS: All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in 4 countries (2005-2019). Neurological, bleeding and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications.RESULTS: N = 501. 118 were women (24%), median age was 56.0 years, median lactate 8.1 mmol/l. Acute myocardial infarction caused CS in 289 patients (58%). 30-day mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor.CONCLUSIONS: Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
AB - BACKGROUND: VA-ECMO restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications.OBJECTIVES: To quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (CPC 1 + 2).METHODS: All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in 4 countries (2005-2019). Neurological, bleeding and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications.RESULTS: N = 501. 118 were women (24%), median age was 56.0 years, median lactate 8.1 mmol/l. Acute myocardial infarction caused CS in 289 patients (58%). 30-day mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor.CONCLUSIONS: Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
KW - Adverse events
KW - Cardiogenic shock
KW - Complications
KW - Mechanical circulatory support
KW - Neurological outcome
KW - Va-ecmo
U2 - 10.1093/ehjacc/zuad129
DO - 10.1093/ehjacc/zuad129
M3 - Original Article (Journal)
C2 - 37875127
SN - 2048-8726
JO - EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
JF - EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
ER -