• Crit Care · Nov 2024

    Intra-aortic balloon pump after VA-ECMO reduces mortality in patients with cardiogenic shock: an analysis of the Chinese extracorporeal life support registry.

    • Kexin Wang, Liangshan Wang, Jiawang Ma, Haixiu Xie, Chenglong Li, Xing Hao, Zhongtao Du, Hong Wang, and Xiaotong Hou.
    • Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
    • Crit Care. 2024 Nov 29; 28 (1): 394394.

    BackgroundThe role of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) remains unclear. This study investigated the effect of applying IABP for left ventricle (LV) unloading after VA-ECMO on reducing mortality in patients with CS.MethodsData from 5,492 consecutive patients with CS treated with VA-ECMO between January 2017 and July 2023 were collected from the CSECLS registry. The primary outcome was in-hospital mortality. The secondary outcomes included 30-day mortality, survival on VA-ECMO, and various complications. The association between the application of IABP after VA-ECMO and in-hospital outcomes was assessed.ResultsAmong 5,492 patients undergoing VA-ECMO (mean age 54.7 ± 15.1 years, 3,917 [71.3%] male), 832 (15.1%) received IABP after VA-ECMO. Before VA-ECMO, a higher incidence of cardiac intervention (13.9% vs. 16.7%) and myocardial infarction (12.0% vs. 14.8%) (all P < 0.05) was seen in the IABP after VA-ECMO group. In this cohort, the IABP after VA-ECMO group had a lower in-hospital mortality (52.5% vs. 48.0%, P = 0.017) and a higher survival rate on VA-ECMO (75.4% vs. 79.4%, P = 0.014). On multivariate modeling, the use of IABP after VA-ECMO was associated with a lower risk of in-hospital mortality (adjusted odds ratio[aOR], 0.823 [95% confidence interval [CI], 0.686-0.987]; P = 0.035) and on-support mortality (aOR, 0.828 [95% CI, 0.688-0.995]; P = 0.044). However, the use of IABP after VA-ECMO was also associated with an increased incidence of complications, including mechanical (aOR: 1.905, [95% CI, 1.278-2.839]; P = 0.002), bleeding (aOR: 1.371, [95% CI, 1.092-1.721]; P = 0.007), renal (aOR: 1.252, [95% CI, 1.041-1.505]; P = 0.017), and pulmonary (aOR: 1.768, [95% CI, 1.446-2.163]; P < 0.001).ConclusionIn this multicenter retrospective study, the use of IABP after VA-ECMO was associated with lower in-hospital mortality in patients with CS. These findings suggest that IABP may offer advantages for LV unloading in patients with CS treated with VA-ECMO, but further validation through randomized controlled trials is warranted to better understand the balance of risks and benefits.© 2024. The Author(s).

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…