Early ECMO does not improve outcomes vs. conservative strategy in cardiogenic shock - Healio

CHICAGO — Early veno-arterial extracorporeal membrane oxygenation for cardiogenic daze did not amended outcomes vs. a blimpish strategy allowing for downstream ECMO successful lawsuit of further hemodynamic decline, a talker reported.

However, contiguous veno-arterial ECMO did trim the likelihood of requiring different mechanical circulatory enactment wrong 30 days owed to further deterioration of hemodynamic presumption compared with the blimpish strategy for rapidly deteriorating oregon terrible cardiogenic shock, according to information presented astatine the American Heart Association Scientific Sessions.

Early veno-arterial ECMO for cardiogenic daze did not amended outcomes vs. a blimpish strategy allowing for downstream ECMO successful lawsuit of further hemodynamic decline.
Photo credit: Scott Buzby, Online Managing Editor

“Immediate implementation of ECMO successful patients with rapidly deteriorating oregon severe cardiogenic shock did not amended objective outcomes compared with an aboriginal blimpish strategy that permitted downstream usage of ECMO successful lawsuit of further hemodynamic worsening,” Petr Ostadal, MD, PhD, prof of medicine successful the section of cardiology astatine Na Homolce Hospital successful Prague, Czech Republic, said during a property conference.

ECMO-CS was a multicenter, investigator-initiated, randomized proceedings that enrolled 117 patients astatine 4 centers successful the Czech Republic with rapidly deteriorating oregon terrible cardiogenic daze to comparison contiguous implementation of veno-arterial ECMO compared with an archetypal blimpish therapy allowing for downstream ECMO successful lawsuit of worsening hemodynamic status.

The superior endpoint was a composite of all-cause mortality, resuscitated circulatory apprehension and implementation of different mechanical circulatory enactment instrumentality astatine 30 days.

Rapidly deteriorating cardiogenic daze was defined arsenic Society for Cardiovascular Angiography and Interventions (SCAI) signifier D to E and terrible cardiogenic daze was defined arsenic SCAI signifier D.

Researchers reported nary important quality betwixt an contiguous veno-arterial ECMO compared with a blimpish strategy for the superior composite endpoint, with a cumulative incidence of 63.8% successful the aboriginal ECMO radical and 71.2% successful the blimpish therapy radical astatine 30 days (HR = 0.72; 95% 0.46-1.12; P = .21).

However, 39% of patients who received the archetypal blimpish strategy ended up requiring downstream ECMO.

Patients who received contiguous veno-arterial ECMO were little apt to necessitate different mechanical circulatory enactment instrumentality wrong 30 days compared with the blimpish strategy (17.2% vs. 42.4%; HR = 0.38; 95% CI, 0.18-0.79). There were nary differences betwixt the groups successful decease oregon resuscitated cardiac apprehension astatine 30 days.

Moreover, determination was nary important quality betwixt aboriginal ECMO and the blimpish strategy for immoderate of the information endpoints, including a composite of superior adverse events that included bleeding, limb ischemia, stroke, pneumonia and sepsis.

“A important proportionality of patients with aboriginal blimpish strategy required downstream usage of ECMO oregon different mechanical circulatory enactment owed to further deterioration of hemodynamic status,” Ostadal said during a presentation. “Therefore, adjacent successful patients with terrible oregon rapidly degenerating cardiogenic shock, aboriginal hemodynamic stabilization utilizing inotropes and vasopressors with implementation of mechanical circulatory enactment lone successful lawsuit of further hemodynamic worsening is simply a therapeutic strategy comparable to the contiguous insertion of ECMO.”

Reference:

• Early usage of ECMO devices did not amended outcomes successful radical with cardiogenic shock. newsroom.heart.org/news/early-use-of-ecmo-devices-did-not-improve-outcomes-in-people-with-cardiogenic-shock. Accessed Nov. 6, 2022. Published Nov. 6, 2022.
• Ostadal P, et al. Circulation. 2022;doi:10.1161/CIRCULATIONAHA.122.062949.