A simple VA-ECMO bundle in adult patients with cardiogenic shock: an analysis of ELSO registry

作者：Liangshan Wang, Kexin Wang, Yán Wāng, Feng Yang, Chenglong Li, Xing Hao, Zhongtao Du, Peter Rycus, Joseph E. Tonna, Eddy Fan, Hong Wang, Xiaotong Hou · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103423 · 被引用次数：2 · 研究领域：Mechanical Circulatory Support Devices、Complement system in diseases、Heparin-Induced Thrombocytopenia and Thrombosis

Background The optimal management strategy for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) remains uncertain. To evaluate the impact of "bundled" physiologic targets on outcomes in VA-ECMO patients. Methods This retrospective cohort study analyzed data from the Extracorporeal Life Support Organization (ELSO) registry, including adult patients receiving VA-ECMO for CS between 2013 and 2022. Patients were grouped by whether they received the full set of bundle components within the first 24 h. The bundle included mean arterial pressure > 65 mmHg, PaO 2 60–150 mmHg, relative change in PaCO 2 [RelΔCO 2 ] > −50% (RelΔCO 2 = [(PaCO 2-24hours −PaCO 2-baseline )/PaCO 2-baseline ] ∗ 100%), and peak inspiratory pressure < 30 mmHg. The primary outcome was survival to hospital discharge, while secondary outcomes were complications. Findings Of 7950 patients (mean age 56.5 ± 14.3 years), 2762 (34.7%) received the complete bundle. The bundle group had significantly higher rates of survival to hospital discharge (55.9% vs. 39.4%, p < 0.001) with adjusted odds ratio [aOR] of 1.849 (95% CI [1.675, 2.042]; p < 0.001), and the likelihood of brain death (aOR = 0.521, 95% CI: 0.289–0.885; p = 0.021), ischemic stroke (aOR = 0.710, 95% CI: 0.559–0.896; p = 0.004), hemorrhagic complications (aOR = 0.773, 95% CI: 0.681–0.876; p < 0.001) and cardiovascular complications (aOR = 0.863, 95% CI: 0.770–0.966; p = 0.011) were reduced. Interpreta...