PMID- 38436727 OWN - NLM STAT- MEDLINE DCOM- 20240321 LR - 20240321 IS - 1432-1238 (Electronic) IS - 0342-4642 (Linking) VI - 50 IP - 3 DP - 2024 Mar TI - Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis. PG - 406-417 LID - 10.1007/s00134-024-07354-2 [doi] AB - PURPOSE: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes of immunocompromised patients treated with VA-ECMO, (2) to identify pre-ECMO predictors of 90-day mortality, (3) to assess the impact of immunodepression on 90-day mortality, and (4) to describe the main ECMO-related complications. METHODS: This is a retrospective, propensity-weighted study conducted in two French experienced ECMO centers. RESULTS: From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32-60) years) received VA-ECMO. The main causes of immunosuppression were long-term corticosteroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90-day and 1-year mortality were 70% (95% confidence interval (CI) 63-77%) and 75% (95% CI 65-79%), respectively. Older age and higher pre-ECMO lactate were independently associated with 90-day mortality. Across immunodepression causes, 1-year mortality ranged from 58% for patients with infection by human immunodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious complications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score-weighted model comparing the 177 patients with 942 non-immunocompromised patients experiencing cardiogenic shock on VA-ECMO, immunocompromised status was independently associated with a higher 90-day mortality (odds ratio 2.53, 95% CI 1.72-3.79). CONCLUSION: Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients. This underscores the necessity for thorough evaluation and careful selection of ECMO candidates within this frail population. CI - (c) 2024. Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Moyon, Quentin AU - Moyon Q AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. FAU - Triboulet, Felicien AU - Triboulet F AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. FAU - Reuter, Jean AU - Reuter J AD - Assistance Publique des Hopitaux de Paris, Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, Paris Diderot University, Sorbonne Paris Cite, INSERM/Paris Diderot University, Paris, France. FAU - Lebreton, Guillaume AU - Lebreton G AD - Assistance Publique des Hopitaux de Paris, Service de Chirurgie Cardiaque, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN, 75013, Paris, France. FAU - Dorget, Amandine AU - Dorget A AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. FAU - Para, Marylou AU - Para M AD - Assistance Publique Des Hopitaux de Paris, Bichat Hospital, Service de Chirurgie Cardiaque, Paris Diderot University, Sorbonne Paris Cite, INSERM/Paris Diderot University, Paris, France. FAU - Chommeloux, Juliette AU - Chommeloux J AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. FAU - Stern, Jules AU - Stern J AD - Assistance Publique Des Hopitaux de Paris, Department of Anesthesiology and Critical Care Medicine, Bichat Hospital, Paris Diderot University, Sorbonne Paris Cite, INSERM/Paris Diderot University, Paris, France. FAU - Pineton de Chambrun, Marc AU - Pineton de Chambrun M AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN, 75013, Paris, France. FAU - Hekimian, Guillaume AU - Hekimian G AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. FAU - Luyt, Charles-Edouard AU - Luyt CE AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. AD - Sorbonne Universite, GRC 30, RESPIRE, Paris, France. FAU - Combes, Alain AU - Combes A AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN, 75013, Paris, France. AD - Sorbonne Universite, GRC 30, RESPIRE, Paris, France. FAU - Sonneville, Romain AU - Sonneville R AD - Assistance Publique des Hopitaux de Paris, Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, Paris Diderot University, Sorbonne Paris Cite, INSERM/Paris Diderot University, Paris, France. FAU - Schmidt, Matthieu AU - Schmidt M AUID- ORCID: 0000-0002-2931-4412 AD - Assistance Publique des Hopitaux de Paris, Service de Medecine Intensive-Reanimation, Institut de Cardiologie, Hopital Pitie-Salpetriere, 75013, Paris, France. matthieu.schmidt@aphp.fr. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, UMRS_1166-ICAN, 75013, Paris, France. matthieu.schmidt@aphp.fr. AD - Sorbonne Universite, GRC 30, RESPIRE, Paris, France. matthieu.schmidt@aphp.fr. AD - Service de Medecine Intensive-Reanimation Hopital Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris Sorbonne Universite, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition 47, Boulevard de L'Hopital, 75013, Paris, France. matthieu.schmidt@aphp.fr. LA - eng PT - Journal Article DEP - 20240304 PL - United States TA - Intensive Care Med JT - Intensive care medicine JID - 7704851 SB - IM MH - Humans MH - Middle Aged MH - *Shock, Cardiogenic/etiology MH - Retrospective Studies MH - *Extracorporeal Membrane Oxygenation/adverse effects MH - Cohort Studies MH - Immunocompromised Host OTO - NOTNLM OT - Cardiogenic shock OT - Extracorporeal membrane oxygenation OT - Immunocompromised status EDAT- 2024/03/04 12:51 MHDA- 2024/03/21 12:43 CRDT- 2024/03/04 11:06 PHST- 2023/11/21 00:00 [received] PHST- 2024/02/11 00:00 [accepted] PHST- 2024/03/21 12:43 [medline] PHST- 2024/03/04 12:51 [pubmed] PHST- 2024/03/04 11:06 [entrez] AID - 10.1007/s00134-024-07354-2 [pii] AID - 10.1007/s00134-024-07354-2 [doi] PST - ppublish SO - Intensive Care Med. 2024 Mar;50(3):406-417. doi: 10.1007/s00134-024-07354-2. Epub 2024 Mar 4.