Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis

Moyon, Q; Triboulet, F; Reuter, J; Lebreton, G; Dorget, A; Para, M; Chommeloux, J; Stern, J; Pineton de Chambrun, M; Hékimian, G; Luyt, CE; Combes, A; Sonneville, R; Schmidt, M

doi:10.1007/s00134-024-07354-2

Organ support & nutrition

Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis

Intensive Care MedPublished 4 Mar 2024Retrospective cohort study

Main finding · 90-day mortalityResultOdds ratio 2.53 95% CI 1.72–3.79

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Authors' conclusion

Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients.

Study context

Population: Critically ill immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), two French ECMO centres, 2006–2022plus 942 non-immunocompromised comparators
Participants: 177 vs 942

Exposure: Immunocompromised vs Non-immunocompromised
Immunocompromisedn = 177
Non-immunocompromisedn = 942reference
Outcome: Mortality
Follow-up: 90 days

Methodological detailspropensity score-weighted, two centres

Propensity score-weighted
Two centres

Main finding

90-day mortality

Odds ratio

2.53

95% CI 1.72–3.79

By group

Overall

70%

95% CI 63–77%

Immunocompromised vs Non-immunocompromised

OR 2.53 (95% CI 1.72–3.79)

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	Values
1-year mortality	Overall 75% (95% CI 65–79%)

1-year mortality: overall mortality of the 177 immunocompromised patients on VA-ECMO

1-year mortality by immunodepression cause (subgroup)

Human immunodeficiency virus (HIV) infection or asplenia: 58%
Solid organ transplant recipients: 89%

Range across immunodepression causes

Safety

ECMO-related complications

Hemorrhagic complications: 39%
Infectious complications: 54%
More than half the intensive care unit (ICU) stay spent on antibiotics

Original publication

Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis. Intensive Care Med. Published 4 March 2024. doi:10.1007/s00134-024-07354-2

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