Earlier ECMO beneficial for patients with refractory cardiogenic shock: Study
Seoul, Korea: Earlier extracorporeal membrane oxygenation (ECMO) support improves clinical outcomes in patients with refractory cardiogenic shock (CS), according to a recent study in the journal JACC: Cardiovascular Interventions.
The prognosis of refractory CS patients receiving ECMO remains poor. However, not much is known about the association between ECMO implantation timing and clinical outcomes in these patients. Considering this, Hyeok-Hee Lee, Yonsei University College of Medicine, Seoul, Korea, and colleagues aimed to investigate whether earlier extracorporeal membrane oxygenation support is associated with improved clinical outcomes in patients with refractory cardiogenic shock.
For this purpose, the researchers identified 362 patients with refractory CS who underwent extracorporeal membrane oxygenation between January 2014 and December 2018 from a multicenter registry. The patients were divided into three groups depending on the tertiles of shock-to-ECMO time -- early, intermediate, and late ECMO.
Key findings of the study include:
- The overall 30-day the mortality rate was 40.9%.
- The risk for 30-day mortality was lower in the early group than in the late group (hazard ratio: 0.53).
- Early ECMO support was also associated with lower risk for in-hospital mortality, ECMO weaning failure, composite of all-cause mortality or rehospitalization for heart failure at 1 year, all-cause mortality at 1 year, and poor neurological outcome at discharge.
- The incidence of adverse events, including stroke, limb ischemia, ECMO-site bleeding, and gastrointestinal bleeding, did not differ significantly among the groups.
"Our findings show that earlier ECMO support was associated with improved clinical outcomes in patients with refractory CS," concluded the authors.
The study titled, "Association Between Timing of Extracorporeal Membrane Oxygenation and Clinical Outcomes in Refractory Cardiogenic Shock," is published in the journal JACC: Cardiovascular Interventions.