PMID- 37797547
OWN - NLM
STAT- MEDLINE
DCOM- 20231113
LR  - 20231113
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 207
DP  - 2023 Nov 15
TI  - Association of Prophylactic Distal Perfusion Cannulation With Mortality in 
      Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation.
PG  - 418-425
LID - S0002-9149(23)00718-X [pii]
LID - 10.1016/j.amjcard.2023.07.149 [doi]
AB  - Prophylactic distal perfusion cannulation (PDPC) is protectively associated with 
      limb ischemia in patients with cardiogenic shock (CS) receiving femoral 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, evidence 
      supporting its benefits beyond limb ischemia reduction is scarce. We aimed to 
      investigate whether PDPC, compared with no-PDPC, is associated with a lower risk 
      of mortality in patients receiving VA-ECMO. From a multicenter registry, we 
      identified 479 patients who underwent VA-ECMO support for refractory CS. The 
      association of PDPC with 30-day mortality was assessed using multiple methods, 
      including instrumental variable analysis, overlap weighting, and propensity score 
      matching. Of the 479 patients, 154 (32.2%) received PDPC. The 30-day mortality 
      rate was 33.1% in the PDPC group and 53.2% in the no-PDPC group. The instrumental 
      variable analysis showed a protective association of PDPC with 30-day mortality 
      (absolute risk difference -16.7%, 95% confidence interval -31.3% to -2.1%; 
      relative risk 0.68, 95% confidence interval 0.40 to 0.96). The findings were 
      consistent in the overlap-weighted analysis (hazard ratio 0.68, 95% confidence 
      interval 0.48 to 0.98) and in the propensity score-matched analysis (hazard ratio 
      0.67, 95% confidence interval 0.45 to 1.00). There were no significant 
      differences in safety outcomes, including stroke, ECMO site bleeding, 
      gastrointestinal bleeding, and sepsis, between PDPC and no-PDPC. In conclusion, 
      PDPC was associated with a lower risk of mortality at 30 days in patients with CS 
      receiving VA-ECMO. The efficacy and safety of PDPC merit evaluation in future 
      randomized studies. Clinical trial registration: ClinicalTrials.gov; NCT02985008.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Lee, Hyeok-Hee
AU  - Lee HH
AD  - Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 
      Korea; Division of Cardiology, Department of Internal Medicine, Severance 
      Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Jang, Woo Jin
AU  - Jang WJ
AD  - Division of Cardiology, Seoul Hospital, Ewha Womans University College of 
      Medicine, Seoul, Korea.
FAU - Ahn, Chul-Min
AU  - Ahn CM
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea. Electronic 
      address: drcello@yuhs.ac.
FAU - Chun, Woo Jung
AU  - Chun WJ
AD  - Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School 
      of Medicine, Changwon, Korea.
FAU - Oh, Ju Hyeon
AU  - Oh JH
AD  - Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School 
      of Medicine, Changwon, Korea.
FAU - Park, Yong Hwan
AU  - Park YH
AD  - Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School 
      of Medicine, Changwon, Korea.
FAU - Lee, Seung-Jun
AU  - Lee SJ
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Hong, Sung-Jin
AU  - Hong SJ
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Yang, Jeong Hoon
AU  - Yang JH
AD  - Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke 
      Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 
      Seoul, Korea.
FAU - Kim, Jung-Sun
AU  - Kim JS
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Kim, Hyeon Chang
AU  - Kim HC
AD  - Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 
      Korea; Division of Cardiology, Department of Internal Medicine, Severance 
      Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Kim, Byeong-Keuk
AU  - Kim BK
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Yu, Cheol Woong
AU  - Yu CW
AD  - Division of Cardiology, Department of Internal Medicine, Korea University Anam 
      Hospital, Korea University College of Medicine, Seoul, Korea.
FAU - Kim, Hyun-Joong
AU  - Kim HJ
AD  - Division of Cardiology, Department of Internal Medicine, Konkuk University 
      Medical Center, School of Medicine, Konkuk University, Seoul, Korea.
FAU - Bae, Jang-Whan
AU  - Bae JW
AD  - Department of Internal Medicine, Chungbuk National University College of 
      Medicine, Cheongju, Korea.
FAU - Ko, Young-Guk
AU  - Ko YG
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Choi, Donghoon
AU  - Choi D
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Gwon, Hyeon-Cheol
AU  - Gwon HC
AD  - Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke 
      Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 
      Seoul, Korea.
FAU - Hong, Myeong-Ki
AU  - Hong MK
AD  - Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular 
      Hospital, Yonsei University College of Medicine, Seoul, Korea.
FAU - Jang, Yangsoo
AU  - Jang Y
AD  - Department of Cardiology, CHA Bundang Medical Center, CHA University College of 
      Medicine, Seongnam, Korea.
LA  - eng
SI  - ClinicalTrials.gov/NCT02985008
PT  - Clinical Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20231003
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Humans
MH  - Catheterization
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Ischemia/etiology/prevention & control
MH  - Perfusion
MH  - *Peripheral Vascular Diseases
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology
OTO - NOTNLM
OT  - distal perfusion
OT  - extracorporeal membrane oxygenation
OT  - mortality
OT  - prophylaxis
COIS- Declaration of Competing Interest The authors have no competing interest to 
      declare.
EDAT- 2023/10/06 00:43
MHDA- 2023/11/06 06:41
CRDT- 2023/10/05 18:08
PHST- 2023/06/10 00:00 [received]
PHST- 2023/07/30 00:00 [accepted]
PHST- 2023/11/06 06:41 [medline]
PHST- 2023/10/06 00:43 [pubmed]
PHST- 2023/10/05 18:08 [entrez]
AID - S0002-9149(23)00718-X [pii]
AID - 10.1016/j.amjcard.2023.07.149 [doi]
PST - ppublish
SO  - Am J Cardiol. 2023 Nov 15;207:418-425. doi: 10.1016/j.amjcard.2023.07.149. Epub 
      2023 Oct 3.