한빛사논문
- 조회394
Min Chul Kim 1, Yongwhan Lim 1, Seung Hun Lee 1, Yoonmin Shin 1, Joon Ho Ahn 1, Dae Young Hyun 1, Kyung Hoon Cho 1, Doo Sun Sim 1, Young Joon Hong 1, Ju Han Kim 1, Myung Ho Jeong 1, Yong Hun Jung 2, In-Seok Jeong 3, Youngkeun Ahn 1
1Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea. (M.C.K., Y.L., S.H.L., Y.S., J.H.A., D.Y.H., K.H.C., D.S.S., Y.J.H., J.H.K., M.H.K., Y.A.).
2Department of Emergency Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea. (Y.H.J.).
3Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea. (I.-S.J.).
Corresponding authors: In-Seok Jeong, Youngkeun Ahn
Abstract
Background: Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) is beneficial for the treatment of profound cardiogenic shock, peripheral VA-ECMO cannulation can increase left ventricular afterload, thus compromising myocardial recovery. We investigated whether early routine left ventricular unloading can reduce 30-day mortality compared with the conventional approach in patients with cardiogenic shock undergoing VA-ECMO.
Methods: This randomized clinical trial involved 116 patients with cardiogenic shock undergoing VA-ECMO from March 2021 to September 2022 at Chonnam National University Hospital, Gwangju, South Korea. The patients were randomly assigned to undergo either early routine left ventricular unloading with transseptal left atrial cannulation within 12 hours after randomization (n=58) or the conventional approach, which permitted rescue transseptal left atrial cannulation in case of an increased left ventricular afterload (n=58). The primary outcome was all-cause mortality within 30 days.
Results: All 116 randomized patients (mean age, 67.6±13.5 years; 34 [29.3%] women) completed the trial. At 30 days, all-cause death had occurred in 27 (46.6%) patients in the early group and 26 (44.8%) patients in the conventional group (hazard ratio, 1.02 [95% CI, 0.59-1.74]; P=0.942). Crossover to rescue transseptal left atrial cannulation occurred in 29 patients (50%) in the conventional group according to a clear indication. Time to rescue transseptal cannulation in the conventional group was a median of 21.8 (interquartile range, 12.4-52.2) hours after randomization. There were no significant differences in other secondary outcomes between the 2 groups except for a shorter time to disappearance of pulmonary congestion in the early group (median, 3 [interquartile range, 2-6] versus 5 [interquartile range, 3-7] days; P=0.027).
Conclusions: Among patients with cardiogenic shock undergoing VA-ECMO, early routine left ventricular unloading with transseptal left atrial cannulation did not reduce 30-day mortality compared with the conventional strategy, which permitted rescue transseptal left atrial cannulation. These findings should be cautiously interpreted until the results of multicenter trials using other unloading modalities become available.
논문정보
- Research article
- 2023년 10월 (BRIC 등록일 2023-10-26)
- 국내 연구진
- 의약학 > 응용의학
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