PMID- 32828186 OWN - NLM STAT- MEDLINE DCOM- 20200908 LR - 20230817 IS - 1474-547X (Electronic) IS - 0140-6736 (Linking) VI - 396 IP - 10250 DP - 2020 Aug 22 TI - Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. PG - 545-552 LID - S0140-6736(20)30733-9 [pii] LID - 10.1016/S0140-6736(20)30733-9 [doi] AB - BACKGROUND: Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments. METHODS: In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged >/=18 years) with septic shock who received VA-ECMO at five academic ECMO centres, with 130 controls (not receiving ECMO) obtained from three large databases of septic shock. All patients had severe myocardial dysfunction (cardiac index 3 L/min per m(2) or less or left ventricular ejection fraction [LVEF] 35% or less) and severe haemodynamic compromise (inotrope score at least 75 mug/kg per min or lactic acidaemia at least 4 mmol/L) at time of inclusion. The primary endpoint was survival at 90 days. A propensity score-weighted analysis was done to control for confounders. FINDINGS: At baseline, patients treated with VA-ECMO had more severe myocardial dysfunction (mean cardiac index 1.5 L/min per m(2)vs 2.2 L/min per m(2), LVEF 17% vs 27%), more severe haemodynamic impairment (inotrope score 279 mug/kg per min vs 145 mug/kg per min, lactataemia 8.9 mmol/L vs 6.5 mmol/L), and more severe organ failure (Sequential Organ Failure Assessment score 17 vs 13) than did controls, with p<0.0001 for each comparison. Survival at 90 days for patients treated with VA-ECMO was significantly higher than for controls (60% vs 25%, risk ratio [RR] for mortality 0.54, 95% CI [0.40-0.70]; p<0.0001). After propensity score weighting, ECMO remained associated with improved survival (51% vs 14%, adjusted RR for mortality 0.57, 95% CI [0.35-0.93]; p=0.0029). Lactate and catecholamine clearance were also significantly enhanced in patients treated with ECMO. Among the 49 survivors treated with ECMO, 32 who had been treated at the largest centre reported satisfactory Short Form-36 evaluated health-related quality of life at 1-year follow-up. INTERPRETATION: Patients with severe sepsis-induced cardiogenic shock treated with VA-ECMO had a large and significant improvement in survival compared with controls not receiving ECMO. However, despite the careful propensity-weighted analysis, we cannot rule out unmeasured confounders. FUNDING: None. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Brechot, Nicolas AU - Brechot N AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; College de France, Centre of Interdisciplinary Research in Biology, CNRS UMR7241, INSERM U1050, Paris, France. Electronic address: nicolas.brechot@aphp.fr. FAU - Hajage, David AU - Hajage D AD - Sorbonne Universite, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Departement Biostatistique Sante Publique et Information Medicale, Centre de Pharmacoepidemiologie (Cephepi), Paris, France. FAU - Kimmoun, Antoine AU - Kimmoun A AD - Service de Medecine Intensive-Reanimation, Centre Hospitalier Universitaire de Nancy and INSERM U1116, Universite de Lorraine, Nancy, France. FAU - Demiselle, Julien AU - Demiselle J AD - Service de Medecine Intensive-Reanimation, Centre Hospitalier Universitaire Angers, Angers, France. FAU - Agerstrand, Cara AU - Agerstrand C AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Centre, and New York-Presbyterian Hospital, Columbia University, New York, NY, USA. FAU - Montero, Santiago AU - Montero S AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Barcelona, Spain; Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Schmidt, Matthieu AU - Schmidt M AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; Sorbonne Universite INSERM-UMRS 1166, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Luyt, Charles-Edouard AU - Luyt CE AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; Sorbonne Universite INSERM-UMRS 1166, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Lebreton, Guillaume AU - Lebreton G AD - Service de Chirurgie Cardiaque et Cardiovasculaire, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; Sorbonne Universite INSERM-UMRS 1166, Institute of Cardiometabolism and Nutrition, Paris, France. FAU - Hekimian, Guillaume AU - Hekimian G AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France. FAU - Flecher, Erwan AU - Flecher E AD - Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire de Rennes, Rennes, France. FAU - Zogheib, Elie AU - Zogheib E AD - Critical Care Department, Amiens University Hospital, Picardy Jules Verne University, Amiens, France. FAU - Levy, Bruno AU - Levy B AD - Service de Medecine Intensive-Reanimation, Centre Hospitalier Universitaire de Nancy and INSERM U1116, Universite de Lorraine, Nancy, France. FAU - Slutsky, Arthur S AU - Slutsky AS AD - Interdepartmental Division of Critical Care Medicine, Departments of Medicine, Surgery and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. FAU - Brodie, Daniel AU - Brodie D AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Centre, and New York-Presbyterian Hospital, Columbia University, New York, NY, USA. FAU - Asfar, Pierre AU - Asfar P AD - Service de Medecine Intensive-Reanimation, Centre Hospitalier Universitaire Angers, Angers, France. FAU - Combes, Alain AU - Combes A AD - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Assistance Publique-Hopitaux de Paris, Hopital Pitie-Salpetriere, Paris, France; Sorbonne Universite INSERM-UMRS 1166, Institute of Cardiometabolism and Nutrition, Paris, France. CN - International ECMO Network LA - eng PT - Journal Article PT - Multicenter Study PL - England TA - Lancet JT - Lancet (London, England) JID - 2985213R SB - IM CIN - Lancet. 2020 Aug 22;396(10250):515-517. PMID: 32828179 CIN - Nat Rev Cardiol. 2020 Nov;17(11):680. PMID: 32913307 CIN - Anaesthesist. 2021 Oct;70(10):888-894. PMID: 34324037 CIN - Am J Respir Crit Care Med. 2023 Jul 15;208(2):196-198. PMID: 37141107 MH - Adult MH - Aged MH - Aged, 80 and over MH - Case-Control Studies MH - Databases, Factual MH - Extracorporeal Membrane Oxygenation/*methods/mortality MH - Female MH - Humans MH - Male MH - Middle Aged MH - Organ Dysfunction Scores MH - Quality of Life MH - Retrospective Studies MH - Shock, Cardiogenic/etiology/mortality/*therapy MH - Shock, Septic/*complications MH - Treatment Outcome EDAT- 2020/08/24 06:00 MHDA- 2020/09/09 06:00 CRDT- 2020/08/24 06:00 PHST- 2020/01/16 00:00 [received] PHST- 2020/02/26 00:00 [revised] PHST- 2020/03/18 00:00 [accepted] PHST- 2020/08/24 06:00 [entrez] PHST- 2020/08/24 06:00 [pubmed] PHST- 2020/09/09 06:00 [medline] AID - S0140-6736(20)30733-9 [pii] AID - 10.1016/S0140-6736(20)30733-9 [doi] PST - ppublish SO - Lancet. 2020 Aug 22;396(10250):545-552. doi: 10.1016/S0140-6736(20)30733-9.