한빛사논문
- 조회377
Hanbit Park 1,2, Jeong Hoon Yang 3, Jung-Min Ahn 1, Do-Yoon Kang 1, Pil Hyung Lee 1, Tae Oh Kim 1, Ki Hong Choi 3, Pil Je Kang 4, Sung-Ho Jung 4, Sung-Cheol Yun 5, Duk-Woo Park 1, Seung-Whan Lee 1, Seung-Jung Park 1, Min-Seok Kim 1
1Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea.
3Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
4Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
5Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Hanbit Park and Jeong Hoon Yang Contributed equally to this article.
CORRESPONDING AUTHOR : Min-Seok Kim
Abstract
Aims: Few studies have reported data on the optimal timing of left ventricular (LV) unloading during venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac arrest or shock. This study evaluated the feasibility of an early LV unloading strategy compared with a conventional strategy in VA-ECMO.
Methods and results: Between December 2018 and August 2022, 60 patients at two institutions were randomized in a 1:1 ratio to receive early (n = 30) or conventional (n = 30) LV unloading strategies. The early LV unloading strategy was defined as LV unloading performed at the time of VA-ECMO insertion. LV unloading was performed using a percutaneous transseptal left atrial cannulation via the femoral vein incorporated into the ECMO venous circuit. The early and conventional LV unloading groups included 29 (96.7%) and 23 (76.7%) patients, respectively (median time from VA-ECMO insertion to LV unloading: 48.4 h, interquartile range 47.8-96.5 h). The groups showed no significant differences in the rate of VA-ECMO weaning as the primary endpoint (70.0% vs. 76.7%; relative risk 0.91; 95% confidence interval 0.67-1.24; p = 0.386) and survival to discharge (53.3% vs. 50.0%, p = 0.796). However, the pulmonary congestion score index at 48 h after LV unloading was significantly improved only in the early LV unloading group (2.0 ± 0.7 vs. 1.7 ± 0.6 at baseline vs. at 48 h; p = 0.008).
Conclusions: Compared with the conventional approach, early LV unloading did not improve the VA-ECMO weaning rate, despite the rapid improvement in pulmonary congestion. Therefore, the results of this study do not support the application of this strategy after VA-ECMO insertion.
논문정보
- Research article
- 2023년 08월 (BRIC 등록일 2023-09-15)
- 국내 연구진
- 의약학 > 응용의학
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