Mortality in patients with cardiogenic shock supported with VA ECMO: A systematic review and meta-analysis evaluating the impact of etiology on 29,289 patients

Alba, Ana Carolina; Foroutan, Farid; Buchan, Tayler A; Álvarez, J. Duerto; Kinsella, A.; Clark, Kathryn; Zhu, Alice; Lau, Kimberley; McGuinty, Caroline; Aleksova, Natasha; Francis, Troy; Stanimirovic, Aleksandra; Vishram-Nielsen, Julie K K; Malik, Abdullah; Ross, Heather J.; Fan, Eddy; Rac, Valeria E.; Rao, Vivek; Billia, Filio

doi:10.1016/j.healun.2021.01.009

Cited by 61 publications

(53 citation statements)

References 26 publications

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“…Recent international registries have reported mortality rates ranging from 38% to 61% for VA-ECMO and 45% to 74% for Impella. 5,22 –24 Our study showed an overall mortality rate of 60%, with similar rates between devices. The systematic approach through protocols showed an increase in the historical survival rates and it has been proposed that CS should be treated in dedicated care centers (Level I).…”

Section: Discussionsupporting

confidence: 67%

“…The mortality rate differs according to the etiology of CS in MCS support. 22 Recent data have shown that cardiac arrest (in and out-of-hospital) and AMI have the highest mortality rates, while myocarditis and post-heart transplant have the lowest. 22 In our cohort, the mortality rates also differed among all etiologies with the highest rates for PE and post-cardiotomy and the lowest for myocarditis and post-heart transplant.…”

Section: Discussionmentioning

confidence: 99%

“…22 Recent data have shown that cardiac arrest (in and out-of-hospital) and AMI have the highest mortality rates, while myocarditis and post-heart transplant have the lowest. 22 In our cohort, the mortality rates also differed among all etiologies with the highest rates for PE and post-cardiotomy and the lowest for myocarditis and post-heart transplant. Recent international registries have reported mortality rates ranging from 38% to 61% for VA-ECMO and 45% to 74% for Impella.…”

Section: Discussionmentioning

confidence: 99%

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Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve

et al. 2022

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Aims: Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil. Methods: Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers’ learning curve. The cohort was divided into two periods: from April 2017 to July 2018 ( n = 24), and from August 2018 to December 2020 ( n = 25). Results: The study enrolled 49 patients [age 59 (43–63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases. Conclusions: Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve

et al. 2022

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“…While there is evidence to suggest wide variability in mortality rates depending on the etiology of cardiogenic shock, the Extracorporeal Life Support Organization (ELSO) registry reveals only 43% of adults on VA ECMO for any cardiac reason will survive to hospital discharge; 30-day survival rates may be as low as one-fourth among the highest risk subpopulation. 2,3 While the ELSO has provided some guidance on the patient population that should be considered for VA ECMO, the decision to initiate this high-risk intervention continues to be made on a case-by-case basis. Providers must often rely on clinical judgment to predict the likelihood of in-hospital and long-term survival, frequently resulting in unfavorable mortality rates, tremendous cost, and overutilization of hospital resources.…”

Section: Introductionmentioning

confidence: 99%

MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support

et al. 2021

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Background: The Model for End-Stage Liver Disease (MELD) score was originally described as a marker of survival in chronic liver disease. More recently, MELD and its derivatives, MELD excluding INR (MELD-XI) and MELD with sodium (MELD-Na), have been applied more broadly as outcome predictors in heart transplant, left ventricular assist device placement, heart failure, and cardiogenic shock, with additional promising data to support the use of these scores for prediction of survival in those undergoing veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods: This study assessed the prognostic impact of MELD in patients with cardiogenic shock undergoing VA ECMO via a single-center retrospective review from January 2014 to March 2020. MELD, MELD-XI, and MELD-Na scores were calculated using laboratory values collected within 48 h of VA ECMO initiation. Multivariate Cox regression analyses determined the association between MELD scores and the primary outcome of 90-day mortality. Receiver operating characteristics (ROC) were used to estimate the discriminatory power for MELD in comparison with previously validated SAVE score. Results: Of the 194 patients, median MELD was 20.1 (13.7–26.2), and 90-day mortality was 62.1%. There was a significant association between MELD score and mortality up to 90 days (hazard ratio (HR) = 1.945, 95% confidence interval (95% CI) = 1.244–3.041, p = 0.004) after adjustment for age, indication for VA ECMO, and sex. The prognostic significance of MELD score for 90-day mortality revealed an AUC of 0.645 (95% CI = 0.565–0.725, p < 0.001). MELD-Na score and MELD-XI score were not associated with mortality. Conclusion: MELD score accurately predicts long-term mortality and may be utilized as a valuable decision-making tool in patients undergoing VA ECMO.

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“…Whether this mode of advanced heart and lung support is associated with a mortality benefit in CS remains unknown however, though proponents believe that it may. 14,15 The field of CS desperately needs randomized controlled trials to examine these newer circulatory support strategies and guide their use. Three trials are ongoing in Europe involving CS and these may finally provide guidance in this regard.…”

mentioning

confidence: 99%

A deceptively simple problem: the case of cardiogenic shock

Baran

2021

European J of Heart Fail

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Mortality in patients with cardiogenic shock supported with VA ECMO: A systematic review and meta-analysis evaluating the impact of etiology on 29,289 patients

Cited by 61 publications

References 26 publications

Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve

Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve

MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support

A deceptively simple problem: the case of cardiogenic shock

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