PMID- 30673888
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2110-5820 (Print)
IS  - 2110-5820 (Electronic)
IS  - 2110-5820 (Linking)
VI  - 9
IP  - 1
DP  - 2019 Jan 23
TI  - Concurrent initiation of intra-aortic balloon pumping with extracorporeal 
      membrane oxygenation reduced in-hospital mortality in postcardiotomy cardiogenic 
      shock.
PG  - 16
LID - 10.1186/s13613-019-0496-9 [doi]
LID - 16
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely 
      used in postcardiotomy cardiac shock (PCS). The factors that affect mortality in 
      patients who receive ECMO for PCS remain unclear. In this study, we analyzed the 
      outcomes, predictive factors and complications of ECMO use for PCS. METHODS: A 
      total of 152 adult subjects who received VA-ECMO for PCS in Fuwai Hospital were 
      consecutively included. We retrospectively collected the baseline 
      characteristics, outcomes and complications. Baseline characteristics were 
      compared between survivors with non-survivors, and logistic regression was 
      performed to identify predictive factors for in-hospital mortality. RESULTS: The 
      mean age of the subjects was 49.5 +/- 14.1 years, with a male dominancy of 73.7%. 
      The main surgical procedures were heart transplantation (32.2%), coronary artery 
      bypass graft (17%) and valvular surgery (11.8%). Intra-aortic balloon pumping 
      (IABP) was initiated concurrently with ECMO in 32.2% subjects and sequentially in 
      18.4% subjects. The ECMO weaning rate was 56.6%, and the in-hospital mortality 
      was 52.0%. When compared with non-survivors, survivors had less hypertension 
      (15.1% vs. 35.4%, p = 0.004), secondary thoracotomy before ECMO initiation (19.2% 
      vs. 39.2%, p = 0.007), pre-ECMO cardiac arrest/ventricular fibrillation (11.0% 
      vs. 34.2%, p = 0.001), bedside implantation of ECMO (11.0% vs. 41.8%, p < 0.001), 
      and more transplant procedure (45.2% vs. 20.3%, p = 0.001), concurrent IABP 
      initiation with ECMO (41.1% vs. 24.1%, p = 0.025). Multivariate logistic 
      regression indicated concurrent IABP initiation with ECMO was the only 
      independent protective factor for in-hospital mortality (OR = 0.375, p = 0.041, 
      95% CI 0.146-0.963). Concurrent IABP initiation with ECMO had less need for 
      continuous renal replacement therapy (30.6% vs. 49.3%, p = 0.039) and less 
      neurological complications (8.2% vs. 22.7%, p = 0.035), but more thrombosis 
      complications (18.4% vs. 2.7%, p = 0.007). CONCLUSION: Concurrent initiation of 
      IABP with ECMO provides better short-term survival for PCS, with reduced 
      peripheral perfusion complications.
FAU - Chen, Kai
AU  - Chen K
AD  - State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center 
      for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of 
      Medical Sciences, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China.
FAU - Hou, Jianfeng
AU  - Hou J
AD  - State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center 
      for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of 
      Medical Sciences, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China.
FAU - Tang, Hanwei
AU  - Tang H
AD  - State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center 
      for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of 
      Medical Sciences, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China.
FAU - Hu, Shengshou
AU  - Hu S
AUID- ORCID: 0000-0001-5487-7949
AD  - State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center 
      for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of 
      Medical Sciences, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China. 
      fwhushengshou@aliyun.com.
LA  - eng
GR  - 2016YFC1300900/The 13th Five-year National Science and Technology Major Project 
      of China/
PT  - Journal Article
DEP - 20190123
PL  - Germany
TA  - Ann Intensive Care
JT  - Annals of intensive care
JID - 101562873
PMC - PMC6344560
OTO - NOTNLM
OT  - Cardiac surgery
OT  - Concurrent initiation
OT  - Extracorporeal membrane oxygenation (ECMO)
OT  - Intra-aortic balloon pumping (IABP)
OT  - Outcomes
OT  - Postcardiotomy cardiogenic shock (PCS)
OT  - Risk factors
EDAT- 2019/01/24 06:00
MHDA- 2019/01/24 06:01
PMCR- 2019/01/23
CRDT- 2019/01/24 06:00
PHST- 2018/10/13 00:00 [received]
PHST- 2019/01/16 00:00 [accepted]
PHST- 2019/01/24 06:00 [entrez]
PHST- 2019/01/24 06:00 [pubmed]
PHST- 2019/01/24 06:01 [medline]
PHST- 2019/01/23 00:00 [pmc-release]
AID - 10.1186/s13613-019-0496-9 [pii]
AID - 496 [pii]
AID - 10.1186/s13613-019-0496-9 [doi]
PST - epublish
SO  - Ann Intensive Care. 2019 Jan 23;9(1):16. doi: 10.1186/s13613-019-0496-9.