Femoro-axillary versus femoro-femoral veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock: A monocentric retrospective study
Rattachement africain : fr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Rationale For veno-arterial extracorporeal membrane oxygenation (ECMO), the femoral artery is the preferred cannulation site (femoro-femoral: Vf-Af). This results in retrograde aortic flow, which increases the left ventricular afterload and can lead to severe pulmonary edema and thrombosis of the cardiac chambers. Right axillary artery cannulation (femoral-axillary: Vf-Aa) provides partial anterograde aortic flow, which may prevent some complications. This study aimed to compare the 90-day mortality and complication rates between VF-AA and VF-AF. Methods Consecutive adult patients with cardiogenic shock who received peripheral VA-ECMO between 2013 and 2019 at our institution were retrospectively included. The exclusion criteria were refractory cardiac arrest, multiple VA-ECMO implantations due to vascular access changes, weaning failure, or ICU readmission. A statistical approach using inverse probability of treatment weighting was used to estimate the effect of the cannulation site on the outcomes. The primary endpoint was the 90-day mortality. The secondary endpoints were vascular access complications, stroke, and other complications related to retrograde blood flow. Outcomes were estimated using logistic regression analysis. Results VA-ECMO was performed on 534 patients. Patients with refractory cardiac arrest ( n = 77 (14%)) and those supported by multiple VA-ECMO ( n = 92, (17%)) were excluded. Out of the 333 patients studied ( n = 209 Vf-Aa; n = 124 VF-AF), the main indications for VA-ECMO implantation were post-cardiotomy (33%, n = 109), dilated cardiomyopathy (20%, n = 66), post-cardiac transplantation (15%, n = 50), acute myocardial infarction (14%, n = 46) and other etiologies (18%, n = 62). The median SOFA score was 9 [7-11], and the crude 90-day mortality rate was 53% ( n = 175). After IPTW, the 90-day mortality was similar in the Vf-Aa and VF-AF groups (54% vs 58%, IPTW-OR = 0.84 [0.54-1.29]). Axillary artery cannulation was associated with significantly fewer local infections (OR = 0.21, 95% CI:0.09-0.51), limb ischemia (OR = 0.37, 95% CI:0.17-0.84), bowel ischemia (OR = 0.16, 95% CI:0.05-0.51) and pulmonary edema (OR = 0.52, 95% CI:0.29-0.92) episodes, but with a higher rate of stroke (OR = 2.87, 95% CI:1.08-7.62) than femoral artery cannulation. Conclusion Compared to VF-AF, axillary cannulation was associated with similar 90-day mortality rates. The high rate of stroke associated with axillary artery cannulation requires further investigation.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Femoro-axillary versus femoro-femoral veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock: A monocentric retrospective study
- Date Crossref
- 12/06/2024
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Assistance Publique – Hôpitaux de Paris pays non établi dans la noticeÉtablissement de santé
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Université Paris Cité pays non établi dans la noticeUniversité ou école supérieure
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Sorbonne Paris Cité pays non établi dans la noticeInstitution
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Laboratoire de Recherche Vasculaire Translationnelle pays non établi dans la noticeStructure de recherche
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Hôpital Bichat-Claude-Bernard pays non établi dans la noticeÉtablissement de santé
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Inserm pays non établi dans la noticeOrganisme public
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Délégation Paris 7 pays non établi dans la noticeOrganisme public
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Physiopathologie et Epidémiologie des Maladies Respiratoires pays non établi dans la noticeStructure de recherche
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Bichat Hospital AP-HP pays non établi dans la noticeÉtablissement de santé
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UMR1148 pays non établi dans la noticeInstitution
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Paris Diderot University Bichat Hospital pays non établi dans la noticeUniversité ou école supérieure
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Université de Paris INSERM Unit U1152 pays non établi dans la noticeUniversité ou école supérieure
Assistance Publique – Hôpitaux de Paris, Université Paris Cité et Sorbonne Paris Cité, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.