key: cord-276141-niy9bgg1
authors: Dai, Qing-Qing; Liu, Yan; Ren, Yu-Dong; Yu, Kai-Jiang; Wang, Hong-Liang
title: Clinical efficacy of extracorporeal membrane oxygenation in cardiogenic shock patients: a multi-center study
date: 2020-09-20
journal: Chin Med J (Engl)
DOI: 10.1097/cm9.0000000000001030
sha: 
doc_id: 276141
cord_uid: niy9bgg1

nan

The design is a multi-center cross-sectional study with the aim to assess the clinical therapeutic efficacy of ECMO and investigate the influence on key parameters. All the CS patients who received ECMO from six hospitals in China from January 2013 to January 2015 were selected (n = 27) as ECMO group, and the control group of 27 CS patients were randomly selected from all the patients who also developed CS in the same period and received conventional therapy. However, due to the fact that five patients in control group abandoned the treatment after initiating treatment, those patients were excluded in the final analysis (n = 22 in the control group). The study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. The study was also approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (No. 2013-Research-06) and all subjects signed written informed consent.

In ECMO group, all the patients received standard ECMO treatment. The patients in control group received conventional treatment including inotropes, diuresis, coronary artery dilation, heart preload, and afterload improvement. Meanwhile, intra-aortic balloon pump counterpulsation, blood purification, or mechanical ventilation was also applied when necessary in both groups.

All statistical analyses were performed using Statistical Analysis System (SAS) (version 9.1.3, SAS Institute Inc., Cary, NC, USA). Spearman rank correlation coefficient was used to analyze the correlation of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score with survival and survival time. Logistic regression analysis was used to analyze the influence of treatment, age, gender, and APACHE II score on survival time. The dynamic changes of variables were analyzed by running repeated measures analysis of variance (ANOVA). A P < 0.05 was considered as statistically significant.

The results showed that the baseline data were not statistically different between the two groups. However, acute physiology and chronic health evaluation II (APACHE II) score in ECMO group was higher than that of control group (Z = 3.64, P = 0.0008), suggesting that the ECMO patients were more severe than the control patients. The mortality rate was 17/27 (62.96%) in ECMO group and 18/22 (81.82%) in control group. However, the mortality rates and survival time were not statistically different between two groups. In addition, APACHE II score in the non-survivors in ECMO group was higher than non-survivors in control group (t = 3.03, P = 0.0064). In 35 non-survivors, Spearman rank correlation analysis showed that APACHE II score was negatively correlated with survival time (r s = À0.43729, P = 0.0097), indicating that higher APACHE II score was correlated with shorter survival time. Multivariant Logistic regression analysis of risk factors for survival time of non-survivors showed that only APACHE II score was statistically significant (odds ratio = 0.0803; 95% confidence interval 0.0069-0.9309; P = 0.0437), suggesting that higher APACHE II score was a risk factor for shorter survival time. It indirectly suggested that the clinical efficacy of ECMO treatment was better compared to the conventional treatment of control group. From clinical experience, ECMO has a great significance in improving systemic circulation and providing gas exchange, which has also been supported in other studies. [5] Repeated measures ANOVA showed that the dynamic changes of mean arterial pressure (MAP), central venous pressure (CVP) and PaO 2 /FiO 2 and creatinine were significantly different between ECMO group and control group. The improvement on MAP, PaO 2 /FiO 2 , and CVP demonstrated that ECMO was more effective than the conventional treatment. The baseline of creatinine in ECMO group was higher than that of control group (P < 0.05). However, the ECMO did not show significant improvement on creatinine. The reason might be that there was already severe kidney dysfunction so it was hard to restore the kidney function even when the perfusion was improved [ Figure 1A -D].

Heart rate (HR), MAP, central venous oxygen saturation (ScvO 2 ), and hemoglobin (Hb) were significantly different between non-survivors and survivors in ECMO group. Hb level can be easily affected by transfusion history. Thus, we did not focus on Hb in the discussion. The generalized linear model for repeated measurement analysis of HR, MAP, and ScvO 2 showed that the outcome of ECMO patients could be estimated based on those factors. In other words, if the factors were not improved within the 1st day, the patient was most probably not going to survive [ Figure 1E -H].

In conclusion, ECMO can improve the survival of CS patients compared with conventional therapy. The dynamic change of MAP, PaO 2 /FiO 2 , and CVP demon-strated that ECMO was more effective than the conventional treatment. The dynamic changes of HR, MAP, and ScvO 2 have certain guiding significance to assess the clinical efficacy and evaluate the prognosis after ECMO application.

The work was supported by grants from the Coronavirus Disease Outbreak Special Project of 2020 from Heilongjiang Provincial Association for Science and Technology Innovation: Research on Coping Strategies of Coronavirus Disease on the Platform of Critical Medicine and International Medical Exchange Foundation of China (No. Z-2018 (No. Z- -35-1902 .

The percutaneous ventricular assist device in severe refractory cardiogenic shock

Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock

Extracorporeal membrane oxygenation support for incessant tachyarrhythmia-induced severe cardiogenic shock

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

Survival analysis after extracorporeal membrane oxygenation in critically ill adults: a nationwide cohort study

Clinical efficacy of extracorporeal membrane oxygenation in cardiogenic shock patients: a multi-center study

Figure 1: The generalized linear mode for repeated measurement analysis of different parameters of extracorporeal membrane oxygenation and control groups (n = 27)

B) central venous pressure

PaO 2 /FiO 2 ; (D) creatinine; (E) heart rate (HR)

F) mean arterial pressure (MAP); (G) ScvO 2 ; (H) Hemoglobin (Hb)

None.