Abstract | BACKGROUND: METHODS: A 7-year database of patients given peripheral VA-ECMO support was used to conduct a propensity-score (PS)-matched analysis to balance their clinical profiles. Patients were classified as 'awake ECMO' or 'non-awake ECMO', respectively, if invasive MV was used during ≤50% or >50% of the VA-ECMO run. Primary outcomes included ventilator-associated pneumonia and ECMO-related complication rates, and secondary outcomes were 60-day and 1-year mortality. A multivariate logistic-regression analysis was used to identify whether MV at cannulation was independently associated with 60-day mortality. RESULTS: Among 231 patients included, 91 (39%) were 'awake' and 140 (61%) 'non-awake'. After PS-matching adjustment, the 'awake ECMO' group had significantly lower rates of pneumonia (35% vs. 59%, P = 0.017), tracheostomy, renal replacement therapy, and less antibiotic and sedative consumption. This strategy was also associated with reduced 60-day (20% vs. 41%, P = 0.018) and 1-year mortality rates (31% vs. 54%, P = 0.021) compared to the 'non-awake' group, respectively. Lastly, MV at ECMO cannulation was independently associated with 60-day mortality. CONCLUSION: An 'awake ECMO' management in VA-ECMO-supported CS patients is feasible, safe, and associated with improved short- and long-term outcomes.
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Authors | Santiago Montero, Florent Huang, Mercedes Rivas-Lasarte, Juliette Chommeloux, Pierre Demondion, Nicolas Bréchot, Guillaume Hékimian, Guillaume Franchineau, Romain Persichini, Charles-Édouard Luyt, Cosme Garcia-Garcia, Antoni Bayes-Genis, Guillaume Lebreton, Juan Cinca, Pascal Leprince, Alain Combes, Jesus Alvarez-Garcia, Matthieu Schmidt |
Journal | European heart journal. Acute cardiovascular care
(Eur Heart J Acute Cardiovasc Care)
Vol. 10
Issue 6
Pg. 585-594
(Aug 24 2021)
ISSN: 2048-8734 [Electronic] England |
PMID | 33822901
(Publication Type: Journal Article)
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Copyright | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]. |
Topics |
- Catheterization
- Extracorporeal Membrane Oxygenation
- Humans
- Retrospective Studies
- Shock, Cardiogenic
(therapy)
- Wakefulness
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