PMID- 38088144 OWN - NLM STAT- MEDLINE DCOM- 20240124 LR - 20240202 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 11 IP - 1 DP - 2024 Feb TI - Ventricular fibrillation/ventricular tachycardia within 72 h of VA-ECMO: incidence, outcomes, risk factors, and management. PG - 524-532 LID - 10.1002/ehf2.14615 [doi] AB - AIMS: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important technique for the treatment of refractory cardiogenic shock and cardiac arrest; however, the early management of ventricular fibrillation/ventricular tachycardia (VF/VT), within 72 h of VA-ECMO, and its effects on patient prognosis remain unclear. METHODS AND RESULTS: We retrospectively analysed patients at the First Affiliated Hospital of Nanjing Medical University who underwent VA-ECMO between January 2017 and March 2022. The patients were divided into two groups, VF/VT and nVF/VT, based on whether or not VF/VT occurred within 72 h after the initiation of VA-ECMO. We utilized logistic regression analysis to evaluate the independent risk factors for VF/VT in patients undergoing VA-ECMO and to ascertain whether the onset of VF/VT affected 28 day survival rate, length of intensive care unit stay, and/or other clinical prognostic factors. Subgroup analysis was performed for the VF/VT group to determine whether defibrillation affected prognosis. In the present study, 126 patients were included, 65.87% of whom were males (83/126), with a mean age of 46.89 +/- 16.23, a 28 day survival rate of 57.14% (72/126), an incidence rate of VF/VT within 72 h of VA-ECMO initiation of 27.78% (35/126), and 80% of whom (28/35) received extracorporeal cardiopulmonary resuscitation. The incidence of VF/VT resulting from cardiac arrest at an early stage was significantly higher than that of refractory cardiogenic shock (80% vs. 20%; P = 0.022). The restricted cubic spline model revealed a U-shaped relationship between VF/VT incidence and initial heart rate (iHR), and multivariate logistic regression analysis showed that an iHR > 120 b.p.m. [odds ratio (OR) 6.117; 95% confidence interval (CI) 1.672-22.376; P = 0.006] and hyperlactataemia (OR 1.125; 95% CI 1.016-1.246; P = 0.023) within 1 h of VA-ECMO initiation were independent risk factors for the occurrence of VF/VT. VF/VT was not found to be associated with the 28 day survival of patients undergoing VA-ECMO support, nor did it affect other secondary endpoints. Defibrillation did not alter the overall prognosis in patients with VF/VT during VA-ECMO. CONCLUSIONS: An iHR > 120 b.p.m. and hyperlactataemia were independent risk factors for the occurrence of VF/VT within 72 h of VA-ECMO initiation. The occurrence of VF/VT does not affect, nor does defibrillation in these patients improve the overall patient prognosis. TRIAL REGISTRATION: ChiCTR1900026105. CI - (c) 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Zhou, Hao AU - Zhou H AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Zhu, Yi AU - Zhu Y AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Zhang, Zhongman AU - Zhang Z AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Mei, Yong AU - Mei Y AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Lv, Jinru AU - Lv J AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Zhang, Gang AU - Zhang G AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Li, Wei AU - Li W AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. FAU - Chen, Xufeng AU - Chen X AD - Emergency Department, Nanjing Medical University First Affiliated Hospital and Jiangsu Province Hospital, Guangzhou Street 300, Nanjing, Jiangsu Province, China. LA - eng GR - NSFC-82072159/National Natural Science Foundation of China/ GR - 2020-155/Jiangsu Province Financial Support Clinical Key Specialty Program/ GR - JSPH-MC-2022-28/Clinical Capacity Enhancement Project of Jiangsu Province Hospital/ PT - Journal Article DEP - 20231213 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Male MH - Humans MH - Adult MH - Middle Aged MH - Female MH - Ventricular Fibrillation/epidemiology/etiology/therapy MH - *Extracorporeal Membrane Oxygenation/methods MH - Incidence MH - Shock, Cardiogenic/epidemiology/etiology/therapy MH - Retrospective Studies MH - *Tachycardia, Ventricular/epidemiology/etiology/therapy MH - *Heart Arrest/epidemiology/therapy/etiology MH - Risk Factors PMC - PMC10804197 OTO - NOTNLM OT - Defibrillation OT - Prognosis OT - Veno-arterial extracorporeal membrane oxygenation OT - Ventricular fibrillation/ventricular tachycardia COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/12/13 06:42 MHDA- 2024/01/24 06:43 PMCR- 2023/12/13 CRDT- 2023/12/13 04:43 PHST- 2023/11/01 00:00 [revised] PHST- 2023/06/20 00:00 [received] PHST- 2023/11/17 00:00 [accepted] PHST- 2024/01/24 06:43 [medline] PHST- 2023/12/13 06:42 [pubmed] PHST- 2023/12/13 04:43 [entrez] PHST- 2023/12/13 00:00 [pmc-release] AID - EHF214615 [pii] AID - 10.1002/ehf2.14615 [doi] PST - ppublish SO - ESC Heart Fail. 2024 Feb;11(1):524-532. doi: 10.1002/ehf2.14615. Epub 2023 Dec 13.