Peripheral-to-central extracorporeal corporeal membrane oxygenation switch in refractory cardiogenic shock patients: outcomes and bridging strategies
Authors' conclusion
The switch from a failing pECMO support to a cECMO as a bridge-to-decision is a possible strategy for a very selected population of young patients with a realistic chance of heart function recovery or heart transplantation.
Study context
- Population
- Patients with refractory cardiogenic shock on peripheral veno-arterial ECMO switched to central ECMO, ECMO-dedicated ICU, February 2006 to January 2023
- Participants
- 80 patients
- Outcome
- In-hospital survival and bridging strategies
Methodological detailsmonocentre
- Monocentre
Main finding
As reported in the abstract
Bridging outcomes and survival
- Successfully bridged
- 30 (38%)
- Bridged to heart transplantation
- 16/80, 20%
- Bridged to recovery
- 10/80, 12%
- Bridged to ventricle assist device (VAD)
- 4/30, 5%
- Died on cECMO
- 50/80, 62%
- In-hospital survival
- 31%
- One-year survival
- 27%
Observational data: associations, not effects.
Further findings
Independent association with in-hospital mortality: MI as cause of refractory cardiogenic shock (rCS)
| HR (CI) | P value | ||
|---|---|---|---|
| MI as cause of rCSOnly variable independently associated | 2.5 (1.3–4.9) | P = 0.009 | |
| 0.20.5125Hazard ratio (log scale) |
Safety
Complications on cECMO
- Need for RRT
- 76%
- Hemothorax or tamponade
- 48%
- Need for surgical revision
- 34%
- Mediastinitis
- 28%
- Stroke
- 28%
Original publication
Peripheral-to-central extracorporeal corporeal membrane oxygenation switch in refractory cardiogenic shock patients: outcomes and bridging strategies. Ann Intensive Care. Published 7 October 2024. doi:10.
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