Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock

Abstract

Mixed cardiogenic-septic shock (MS), defined as the combination of cardiogenic (CS) and septic (SS) shock, is often encountered in cardiac intensive care units. Herein, the authors compared the impact of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in MS, CS, and SS. Of 1,023 patients who received VA-ECMO from January 2012 to February 2020 at a single center, 211 with pulmonary embolism, hypovolemic shock, aortic dissection, and unknown causes of shock were excluded. The remaining 812 patients were grouped based on the cause of shock at VA-ECMO application: i) MS (n = 246, 30.3%), ii) CS (n = 466, 57.4%), iii) SS (n = 100, 12.3%). The MS group was younger and had lower left ventricular ejection fraction than the CS or SS group did. The 30 day and 1 year mortalities were the highest in SS (30 day mortality: 50.4% vs. 43.3% vs. 69.0%, p < 0.001 for MS versus CS versus SS, respectively; 1 year mortality: 67.5% vs. 53.2% vs. 81.0%, p < 0.001 for MS versus CS versus SS, respectively). Posthoc analysis showed that the 30 day mortality of MS was not different from CS, while the 1 year mortality of MS was worse than CS but better than SS. Venoarterial extracorporeal membrane oxygenation application for MS may help improve survival and should therefore be considered if indicated.

Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes

“…[1][2][3] Traditional criteria defining systemic inflammatory response syndrome and sepsis overlap with the critical state of the patient with CS, 11,12 and absolute diagnostic clinical, laboratory, and hemodynamic cutoffs are impossible to apply and generalize due to the heterogeneous nature of the CS population. In addition, the majority of the studies focusing on the MS condition actually considered qualitative diagnostic criteria or administrative codes [1][2][3]16 (an overview of currently available definitions is reported in the Supplemental Material). Thus, among the goals of this study, there was the need to propose and test the prognostic relevance of a prespecified, quantitative, and reproducible definition of MS complicating CS.…”

Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

“…Kim et al. [ 76 ] revealed that VA ECMO may help improve survival in patients with septic shock and cardiogenic shock. Cheng et al.…”

Elucidating the Interplay: Exploring the Impact of Acute Heart Failure on Aspiration Pneumonia Hospitalizations

“…This scenario is often termed “mixed shock.” Despite limited research, outcomes appear no more favorable than with individual cardiogenic or septic shock. 8) Studies suggest increased use of vasoactive drugs 9) and a potential benefit of short-term prognosis through treatments such as mechanical circulatory support, 10) signifying a possible avenue for improvement. The composition of cardiac intensive care units is evolving as patient profiles become increasingly diverse, warranting heightened interest in novel disease categories.…”