Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience
<h3>Objective </h3><p dir="ltr">The use of Intra-Aortic Balloon Pump (IABP) has been suggested to unload the left ventricle (LV) while on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital morta...
محفوظ في:
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| مؤلفون آخرون: | , , , , , , , , , , , |
| منشور في: |
2025
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| _version_ | 1864513552092495872 |
|---|---|
| author | Alaa Rahhal (14150403) |
| author2 | Ousama Bilal (10005795) Ahmed Abdelsalam (12070669) Praveen Sivadasan (20090730) Ammar Al Abdullah (20568125) Safae Abuyousef (17347054) Siddiha Shahulhameed (20568128) Khaled Zaza (20568131) Abdulwahid Al Mulla (20568134) Abdulaziz Alkhulaifi (16932540) Ahmed Mahfouz (737928) Sumaya Alyafei (14147868) Amr Omar (10063676) |
| author2_role | author author author author author author author author author author author author |
| author_facet | Alaa Rahhal (14150403) Ousama Bilal (10005795) Ahmed Abdelsalam (12070669) Praveen Sivadasan (20090730) Ammar Al Abdullah (20568125) Safae Abuyousef (17347054) Siddiha Shahulhameed (20568128) Khaled Zaza (20568131) Abdulwahid Al Mulla (20568134) Abdulaziz Alkhulaifi (16932540) Ahmed Mahfouz (737928) Sumaya Alyafei (14147868) Amr Omar (10063676) |
| author_role | author |
| dc.creator.none.fl_str_mv | Alaa Rahhal (14150403) Ousama Bilal (10005795) Ahmed Abdelsalam (12070669) Praveen Sivadasan (20090730) Ammar Al Abdullah (20568125) Safae Abuyousef (17347054) Siddiha Shahulhameed (20568128) Khaled Zaza (20568131) Abdulwahid Al Mulla (20568134) Abdulaziz Alkhulaifi (16932540) Ahmed Mahfouz (737928) Sumaya Alyafei (14147868) Amr Omar (10063676) |
| dc.date.none.fl_str_mv | 2025-01-13T09:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1053/j.jvca.2025.01.013 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Predictors_of_Mortality_in_Veno-Arterial_Extracorporeal_Membrane_Oxygenation_Regardless_of_Early_Left_Ventricular_Unloading_A_National_Experience/28217825 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Intra-Aortic Balloon Pump Veno-Arterial Extracorporeal Membrane Oxygenation Left Ventricular Unloading Cardiogenic Shock |
| dc.title.none.fl_str_mv | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Objective </h3><p dir="ltr">The use of Intra-Aortic Balloon Pump (IABP) has been suggested to unload the left ventricle (LV) while on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital mortality. However, the predictors of mortality on dual mechanical circulatory support (MCS) have not yet been evaluated, especially in real-world clinical settings. Therefore, we conducted a case-control study to determine the rate of all-cause mortality associated with VA-ECMO use regardless of LV unloading, and with early LV unloading in the setting of CS, and to identify the predictors of mortality associated with VA-ECMO, and with concurrent early LV unloading. </p><h3>Design </h3><p dir="ltr">Retrospective observational case-control study. </p><h3>Setting </h3><p dir="ltr">National tertiary cardiology center. </p><h3>Participants </h3><p dir="ltr">All patients with CS requiring VA-ECMO cannulation during the index admission between 1/06/2016 and 1/06/2022. </p><h3>Intervention</h3><p dir="ltr">VA-ECMO with or without IABP.</p><h3>Measurements and Main Results </h3><p dir="ltr">Patient- and disease-related characteristics associated with in-hospital 30-day mortality following VA-ECMO with and without IABP support were assessed using multivariate logistic regression. Results were presented as odds ratio (OR), and a P-value <0.05 indicated statistical significance. A total of 110 patients were included. Most of the patients were male (90%) with a mean age of 53±11 years. Around 67% were Asian. The majority of patients were admitted with ST-elevation myocardial infarction (87%) with 26% presenting with left main (LM) disease. In-hospital 30-day mortality occurred in 42.7% among those who received VA-ECMO support regardless of IABP use, while it was 46.9% among those receiving early LV unloading with IABP. The significant positive predictors of mortality with VA-ECMO regardless of IABP in CS were CPR > 20 minutes (aOR 14.74, 95% CI 2.02-107.41; p-value= 0.008), older age (i.e., greater than 55 years) and LM disease of more than 50% stenosis were associated with a fourfold increase in the odds of mortality while on VA-ECMO. Whereas CPR > 20 minutes (aOR 12.45, 95% CI 1.79-86.36; <i>p</i>-value= 0.011) was the only significant positive predictor of mortality with VA-ECMO and IABP. </p><h3>Conclusion </h3><p dir="ltr">Mortality rate in CS requiring VA-ECMO regardless of IABP use remains high. However, only one predictor (i.e. prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading, suggesting that concomitant IABP use might minimize the effect of mortality predictors.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Cardiothoracic and Vascular Anesthesia<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1053/j.jvca.2025.01.013" target="_blank">https://dx.doi.org/10.1053/j.jvca.2025.01.013</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_fd8ecb7cbf93a8876cb2a21b9185f211 |
| identifier_str_mv | 10.1053/j.jvca.2025.01.013 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/28217825 |
| publishDate | 2025 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National ExperienceAlaa Rahhal (14150403)Ousama Bilal (10005795)Ahmed Abdelsalam (12070669)Praveen Sivadasan (20090730)Ammar Al Abdullah (20568125)Safae Abuyousef (17347054)Siddiha Shahulhameed (20568128)Khaled Zaza (20568131)Abdulwahid Al Mulla (20568134)Abdulaziz Alkhulaifi (16932540)Ahmed Mahfouz (737928)Sumaya Alyafei (14147868)Amr Omar (10063676)Biomedical and clinical sciencesCardiovascular medicine and haematologyIntra-Aortic Balloon PumpVeno-Arterial Extracorporeal Membrane OxygenationLeft Ventricular UnloadingCardiogenic Shock<h3>Objective </h3><p dir="ltr">The use of Intra-Aortic Balloon Pump (IABP) has been suggested to unload the left ventricle (LV) while on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital mortality. However, the predictors of mortality on dual mechanical circulatory support (MCS) have not yet been evaluated, especially in real-world clinical settings. Therefore, we conducted a case-control study to determine the rate of all-cause mortality associated with VA-ECMO use regardless of LV unloading, and with early LV unloading in the setting of CS, and to identify the predictors of mortality associated with VA-ECMO, and with concurrent early LV unloading. </p><h3>Design </h3><p dir="ltr">Retrospective observational case-control study. </p><h3>Setting </h3><p dir="ltr">National tertiary cardiology center. </p><h3>Participants </h3><p dir="ltr">All patients with CS requiring VA-ECMO cannulation during the index admission between 1/06/2016 and 1/06/2022. </p><h3>Intervention</h3><p dir="ltr">VA-ECMO with or without IABP.</p><h3>Measurements and Main Results </h3><p dir="ltr">Patient- and disease-related characteristics associated with in-hospital 30-day mortality following VA-ECMO with and without IABP support were assessed using multivariate logistic regression. Results were presented as odds ratio (OR), and a P-value <0.05 indicated statistical significance. A total of 110 patients were included. Most of the patients were male (90%) with a mean age of 53±11 years. Around 67% were Asian. The majority of patients were admitted with ST-elevation myocardial infarction (87%) with 26% presenting with left main (LM) disease. In-hospital 30-day mortality occurred in 42.7% among those who received VA-ECMO support regardless of IABP use, while it was 46.9% among those receiving early LV unloading with IABP. The significant positive predictors of mortality with VA-ECMO regardless of IABP in CS were CPR > 20 minutes (aOR 14.74, 95% CI 2.02-107.41; p-value= 0.008), older age (i.e., greater than 55 years) and LM disease of more than 50% stenosis were associated with a fourfold increase in the odds of mortality while on VA-ECMO. Whereas CPR > 20 minutes (aOR 12.45, 95% CI 1.79-86.36; <i>p</i>-value= 0.011) was the only significant positive predictor of mortality with VA-ECMO and IABP. </p><h3>Conclusion </h3><p dir="ltr">Mortality rate in CS requiring VA-ECMO regardless of IABP use remains high. However, only one predictor (i.e. prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading, suggesting that concomitant IABP use might minimize the effect of mortality predictors.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Cardiothoracic and Vascular Anesthesia<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1053/j.jvca.2025.01.013" target="_blank">https://dx.doi.org/10.1053/j.jvca.2025.01.013</a></p>2025-01-13T09:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1053/j.jvca.2025.01.013https://figshare.com/articles/journal_contribution/Predictors_of_Mortality_in_Veno-Arterial_Extracorporeal_Membrane_Oxygenation_Regardless_of_Early_Left_Ventricular_Unloading_A_National_Experience/28217825CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/282178252025-01-13T09:00:00Z |
| spellingShingle | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience Alaa Rahhal (14150403) Biomedical and clinical sciences Cardiovascular medicine and haematology Intra-Aortic Balloon Pump Veno-Arterial Extracorporeal Membrane Oxygenation Left Ventricular Unloading Cardiogenic Shock |
| status_str | publishedVersion |
| title | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| title_full | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| title_fullStr | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| title_full_unstemmed | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| title_short | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| title_sort | Predictors of Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Intra-Aortic Balloon Pump Veno-Arterial Extracorporeal Membrane Oxygenation Left Ventricular Unloading Cardiogenic Shock |