Oxygenation management during veno-arterial ECMO support for cardiogenic shock: a multicentric retrospective cohort study
Authors' conclusion
In a multicentric cohort of cardiogenic shock supported by VA ECMO, the median value for FSO2 mean (day 1-7) was 70 [57; 79] %. PPOSTO2 monitoring was infrequent and revealed significant hyperoxemia. Higher FSO2 mean (day 1-3) and right radial PaO2 mean (day 1-3) were independently associated with in-ICU mortality.
Study context
- Population
- Patients with cardiogenic shock on peripheral VA ECMO support (extracorporeal CPR excluded), 14 ECMO centers in France and one in Switzerland, August 2019–March 2022ECMO centres in France and Switzerland
- Participants
- 139 patients
- Outcome
- Individual mean sweep gas oxygen fraction (FSO2 mean (day 1-7))
- Follow-up
- First 7 days of ECMO support
Methodological detailsmulticentric
- Multicentric
Main finding
As reported in the abstract
Individual mean FSO2 during the first 7 days of ECMO support (FSO2 mean (day 1-7)) · day 1-7
Median FSO2 mean (day 1-7) [IQR]
70 [57; 79] %
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Maintaining FSO2 ≥ 70%, centres with <30 VA-ECMO runs per year vs high volume centres | 5.04 ([1.39; 20.4]) | P = 0.017 | |
| 0.050.21520Odds ratio (log scale) |
Factors associated with in-ICU mortality (multivariate analysis)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Age | 1.07 ([1.03-1.11]) | P < 0.001 | |
| FSO2 mean (day 1-3) | 1.03 ([1.00-1.06]) | P = 0.039 | |
| Right radial PaO2 mean (day 1-3)CI as printed | 1.03 ([1.00-1.02]) | P = 0.023 | |
| 0.512Odds ratio (log scale) |
Right radial PaO2 mean (day 1-7)
- Median right radial PaO2 mean (day 1-7) [IQR]
- 114 [92; 145] mmHg
- Right radial PaO2 at day 1
- 125 [86; 207] mmHg
- Right radial PaO2 at day 3 (decrease from day 1, p < 0.01)
- 97 [81; 133] mmHg
Severe hyperoxemia (right radial PaO2 ≥ 300 mmHg)
- Patients with severe hyperoxemia
- 16 patients (12%)
PPOSTO2 (surrogate of lower body oxygenation) · day 1-7
- Measured in only
- 39 patients (28%) among four centers
- Median PPOSTO2 mean (day 1-7) [IQR]
- 198 [169; 231] mmHg
Original publication
Oxygenation management during veno-arterial ECMO support for cardiogenic shock: a multicentric retrospective cohort study. Ann Intensive Care. Published 10 April 2024. doi:10.
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