View in EDS

Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study.

Saved in:
Bibliographic Details
Title: Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study.
Authors: Bréchot, Nicolas (AUTHOR), Hajage, David (AUTHOR), Kimmoun, Antoine (AUTHOR), Demiselle, Julien (AUTHOR), Agerstrand, Cara (AUTHOR), Montero, Santiago (AUTHOR), Schmidt, Matthieu (AUTHOR), Luyt, Charles-Edouard (AUTHOR), Lebreton, Guillaume (AUTHOR), Hékimian, Guillaume (AUTHOR), Flecher, Erwan (AUTHOR), Zogheib, Elie (AUTHOR), Levy, Bruno (AUTHOR), Slutsky, Arthur S (AUTHOR), Brodie, Daniel (AUTHOR), Asfar, Pierre (AUTHOR), Combes, Alain (AUTHOR), International ECMO Network (CORPORATE AUTHOR)
Source: Lancet. 8/22/2020, Vol. 396 Issue 10250, p545-552. 8p.
Subjects: Extracorporeal membrane oxygenation, Cardiogenic shock, Septic shock, Ventricular ejection fraction, Cohort analysis, Databases, Research, Research methodology, Case-control method, Health status indicators, Retrospective studies, Evaluation research, Medical cooperation, Treatment effectiveness, Comparative studies, Quality of life, Disease complications
Abstract: Background: Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments.Methods: In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged ≥18 years) with septic shock who received VA-ECMO at five academic ECMO centres, with 130 controls (not receiving ECMO) obtained from three large databases of septic shock. All patients had severe myocardial dysfunction (cardiac index 3 L/min per m2 or less or left ventricular ejection fraction [LVEF] 35% or less) and severe haemodynamic compromise (inotrope score at least 75 μg/kg per min or lactic acidaemia at least 4 mmol/L) at time of inclusion. The primary endpoint was survival at 90 days. A propensity score-weighted analysis was done to control for confounders.Findings: At baseline, patients treated with VA-ECMO had more severe myocardial dysfunction (mean cardiac index 1·5 L/min per m2vs 2·2 L/min per m2, LVEF 17% vs 27%), more severe haemodynamic impairment (inotrope score 279 μg/kg per min vs 145 μg/kg per min, lactataemia 8·9 mmol/L vs 6·5 mmol/L), and more severe organ failure (Sequential Organ Failure Assessment score 17 vs 13) than did controls, with p<0·0001 for each comparison. Survival at 90 days for patients treated with VA-ECMO was significantly higher than for controls (60% vs 25%, risk ratio [RR] for mortality 0·54, 95% CI [0·40-0·70]; p<0·0001). After propensity score weighting, ECMO remained associated with improved survival (51% vs 14%, adjusted RR for mortality 0·57, 95% CI [0·35-0·93]; p=0·0029). Lactate and catecholamine clearance were also significantly enhanced in patients treated with ECMO. Among the 49 survivors treated with ECMO, 32 who had been treated at the largest centre reported satisfactory Short Form-36 evaluated health-related quality of life at 1-year follow-up.Interpretation: Patients with severe sepsis-induced cardiogenic shock treated with VA-ECMO had a large and significant improvement in survival compared with controls not receiving ECMO. However, despite the careful propensity-weighted analysis, we cannot rule out unmeasured confounders.Funding: None. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
FullText Text:
  Availability: 0
Header DbId: pbh
DbLabel: Psychology and Behavioral Sciences Collection
An: 145444037
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study.
– Name: Author
  Label: Authors
  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Br&#233;chot%2C+Nicolas%22&quot;&gt;Br&#233;chot, Nicolas&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hajage%2C+David%22&quot;&gt;Hajage, David&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kimmoun%2C+Antoine%22&quot;&gt;Kimmoun, Antoine&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Demiselle%2C+Julien%22&quot;&gt;Demiselle, Julien&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Agerstrand%2C+Cara%22&quot;&gt;Agerstrand, Cara&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Montero%2C+Santiago%22&quot;&gt;Montero, Santiago&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schmidt%2C+Matthieu%22&quot;&gt;Schmidt, Matthieu&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Luyt%2C+Charles-Edouard%22&quot;&gt;Luyt, Charles-Edouard&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lebreton%2C+Guillaume%22&quot;&gt;Lebreton, Guillaume&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22H&#233;kimian%2C+Guillaume%22&quot;&gt;H&#233;kimian, Guillaume&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Flecher%2C+Erwan%22&quot;&gt;Flecher, Erwan&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Zogheib%2C+Elie%22&quot;&gt;Zogheib, Elie&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Levy%2C+Bruno%22&quot;&gt;Levy, Bruno&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Slutsky%2C+Arthur+S%22&quot;&gt;Slutsky, Arthur S&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Brodie%2C+Daniel%22&quot;&gt;Brodie, Daniel&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Asfar%2C+Pierre%22&quot;&gt;Asfar, Pierre&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Combes%2C+Alain%22&quot;&gt;Combes, Alain&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22International+ECMO+Network%22&quot;&gt;International ECMO Network&lt;/searchLink&gt; (CORPORATE AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Lancet%22&quot;&gt;Lancet&lt;/searchLink&gt;. 8/22/2020, Vol. 396 Issue 10250, p545-552. 8p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Extracorporeal+membrane+oxygenation%22&quot;&gt;Extracorporeal membrane oxygenation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cardiogenic+shock%22&quot;&gt;Cardiogenic shock&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Septic+shock%22&quot;&gt;Septic shock&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Ventricular+ejection+fraction%22&quot;&gt;Ventricular ejection fraction&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cohort+analysis%22&quot;&gt;Cohort analysis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Databases%22&quot;&gt;Databases&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Research%22&quot;&gt;Research&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Research+methodology%22&quot;&gt;Research methodology&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Case-control+method%22&quot;&gt;Case-control method&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Health+status+indicators%22&quot;&gt;Health status indicators&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Retrospective+studies%22&quot;&gt;Retrospective studies&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Evaluation+research%22&quot;&gt;Evaluation research&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Medical+cooperation%22&quot;&gt;Medical cooperation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Treatment+effectiveness%22&quot;&gt;Treatment effectiveness&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Comparative+studies%22&quot;&gt;Comparative studies&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Quality+of+life%22&quot;&gt;Quality of life&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Disease+complications%22&quot;&gt;Disease complications&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: &lt;bold&gt;Background: &lt;/bold&gt;Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments.&lt;bold&gt;Methods: &lt;/bold&gt;In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged ≥18 years) with septic shock who received VA-ECMO at five academic ECMO centres, with 130 controls (not receiving ECMO) obtained from three large databases of septic shock. All patients had severe myocardial dysfunction (cardiac index 3 L/min per m2 or less or left ventricular ejection fraction [LVEF] 35% or less) and severe haemodynamic compromise (inotrope score at least 75 μg/kg per min or lactic acidaemia at least 4 mmol/L) at time of inclusion. The primary endpoint was survival at 90 days. A propensity score-weighted analysis was done to control for confounders.&lt;bold&gt;Findings: &lt;/bold&gt;At baseline, patients treated with VA-ECMO had more severe myocardial dysfunction (mean cardiac index 1&#183;5 L/min per m2vs 2&#183;2 L/min per m2, LVEF 17% vs 27%), more severe haemodynamic impairment (inotrope score 279 μg/kg per min vs 145 μg/kg per min, lactataemia 8&#183;9 mmol/L vs 6&#183;5 mmol/L), and more severe organ failure (Sequential Organ Failure Assessment score 17 vs 13) than did controls, with p&lt;0&#183;0001 for each comparison. Survival at 90 days for patients treated with VA-ECMO was significantly higher than for controls (60% vs 25%, risk ratio [RR] for mortality 0&#183;54, 95% CI [0&#183;40-0&#183;70]; p&lt;0&#183;0001). After propensity score weighting, ECMO remained associated with improved survival (51% vs 14%, adjusted RR for mortality 0&#183;57, 95% CI [0&#183;35-0&#183;93]; p=0&#183;0029). Lactate and catecholamine clearance were also significantly enhanced in patients treated with ECMO. Among the 49 survivors treated with ECMO, 32 who had been treated at the largest centre reported satisfactory Short Form-36 evaluated health-related quality of life at 1-year follow-up.&lt;bold&gt;Interpretation: &lt;/bold&gt;Patients with severe sepsis-induced cardiogenic shock treated with VA-ECMO had a large and significant improvement in survival compared with controls not receiving ECMO. However, despite the careful propensity-weighted analysis, we cannot rule out unmeasured confounders.&lt;bold&gt;Funding: &lt;/bold&gt;None. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: &lt;i&gt;Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=145444037
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1016/S0140-6736(20)30733-9
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 545
    Subjects:
      – SubjectFull: Extracorporeal membrane oxygenation
        Type: general
      – SubjectFull: Cardiogenic shock
        Type: general
      – SubjectFull: Septic shock
        Type: general
      – SubjectFull: Ventricular ejection fraction
        Type: general
      – SubjectFull: Cohort analysis
        Type: general
      – SubjectFull: Databases
        Type: general
      – SubjectFull: Research
        Type: general
      – SubjectFull: Research methodology
        Type: general
      – SubjectFull: Case-control method
        Type: general
      – SubjectFull: Health status indicators
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Evaluation research
        Type: general
      – SubjectFull: Medical cooperation
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Quality of life
        Type: general
      – SubjectFull: Disease complications
        Type: general
    Titles:
      – TitleFull: Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Bréchot, Nicolas
      – PersonEntity:
          Name:
            NameFull: Hajage, David
      – PersonEntity:
          Name:
            NameFull: Kimmoun, Antoine
      – PersonEntity:
          Name:
            NameFull: Demiselle, Julien
      – PersonEntity:
          Name:
            NameFull: Agerstrand, Cara
      – PersonEntity:
          Name:
            NameFull: Montero, Santiago
      – PersonEntity:
          Name:
            NameFull: Schmidt, Matthieu
      – PersonEntity:
          Name:
            NameFull: Luyt, Charles-Edouard
      – PersonEntity:
          Name:
            NameFull: Lebreton, Guillaume
      – PersonEntity:
          Name:
            NameFull: Hékimian, Guillaume
      – PersonEntity:
          Name:
            NameFull: Flecher, Erwan
      – PersonEntity:
          Name:
            NameFull: Zogheib, Elie
      – PersonEntity:
          Name:
            NameFull: Levy, Bruno
      – PersonEntity:
          Name:
            NameFull: Slutsky, Arthur S
      – PersonEntity:
          Name:
            NameFull: Brodie, Daniel
      – PersonEntity:
          Name:
            NameFull: Asfar, Pierre
      – PersonEntity:
          Name:
            NameFull: Combes, Alain
      – PersonEntity:
          Name:
            NameFull: International ECMO Network
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 22
              M: 08
              Text: 8/22/2020
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-print
              Value: 01406736
          Numbering:
            – Type: volume
              Value: 396
            – Type: issue
              Value: 10250
          Titles:
            – TitleFull: Lancet
              Type: main
ResultId 1