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- Title
Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis.
- Authors
Moyon, Quentin; Triboulet, Félicien; Reuter, Jean; Lebreton, Guillaume; Dorget, Amandine; Para, Marylou; Chommeloux, Juliette; Stern, Jules; Pineton de Chambrun, Marc; Hékimian, Guillaume; Luyt, Charles-Edouard; Combes, Alain; Sonneville, Romain; Schmidt, Matthieu
- Abstract
Purpose: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes of immunocompromised patients treated with VA-ECMO, (2) to identify pre-ECMO predictors of 90-day mortality, (3) to assess the impact of immunodepression on 90-day mortality, and (4) to describe the main ECMO-related complications. Methods: This is a retrospective, propensity-weighted study conducted in two French experienced ECMO centers. Results: From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32–60) years) received VA-ECMO. The main causes of immunosuppression were long-term corticosteroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90-day and 1-year mortality were 70% (95% confidence interval (CI) 63–77%) and 75% (95% CI 65–79%), respectively. Older age and higher pre-ECMO lactate were independently associated with 90-day mortality. Across immunodepression causes, 1-year mortality ranged from 58% for patients with infection by human immunodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious complications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score-weighted model comparing the 177 patients with 942 non-immunocompromised patients experiencing cardiogenic shock on VA-ECMO, immunocompromised status was independently associated with a higher 90-day mortality (odds ratio 2.53, 95% CI 1.72–3.79). Conclusion: Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients. This underscores the necessity for thorough evaluation and careful selection of ECMO candidates within this frail population.
- Subjects
CARDIOGENIC shock; EXTRACORPOREAL membrane oxygenation; IMMUNOCOMPROMISED patients; HIV infections; COHORT analysis; INTENSIVE care units
- Publication
Intensive Care Medicine, 2024, Vol 50, Issue 3, p406
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-024-07354-2