Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00669806%3A_____%2F25%3A10499634" target="_blank" >RIV/00669806:_____/25:10499634 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11110/25:10499634 RIV/00216208:11130/25:10499634 RIV/00216208:11140/25:10499634 RIV/00064203:_____/25:10499634 and 2 more

Result on the web

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=Vz_-4Jpzbz" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=Vz_-4Jpzbz</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1186/s13054-025-05513-5" target="_blank" >10.1186/s13054-025-05513-5</a>

Result language

angličtina

Original language name

Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial

Original language description

BACKGROUND: Immediate initiation of extracorporeal membrane oxygenation (ECMO) has not demonstrated benefit in individuals diagnosed with cardiogenic shock based on the presence of hypotension. The relationship between other hemodynamic or metabolic parameters and clinical outcomes, with or without ECMO, is not fully understood. METHODS: The Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock (ECMO-CS) trial randomly assigned 117 patients diagnosed with cardiogenic shock to 2 groups: immediate initiation of ECMO or early conservative strategy. The present post-hoc analysis investigated the clinical efficacy of immediate ECMO therapy in subgroups with cardiogenic shock-more specific characteristics: low cardiac index, low venous oxygen saturation (SvO(2)) and high partial carbon dioxide pressure (pCO(2)) gap. The primary endpoint for this analysis was 1-year all-cause mortality; the secondary endpoint was a composite of mortality or hemodynamic worsening requiring ECMO. RESULTS: Data regarding cardiac index were available for 58 patients. In the subgroup with cardiac index &lt; 2.2 L/min/m(2), immediate ECMO initiation was associated with a reduced risk for all-cause death (hazard ratio [HR] 0.48 [95% confidence interval (CI) 0.23-0.99]; p = 0.049; number needed to treat to prevent one death [NNT] 3.6) and composite of all-cause death or hemodynamic worsening (HR 0.30 [95% CI 0.15-0.65]; p = 0.003). Data regarding pCO(2) gap were available for 54 patients and, in the subgroup with pCO(2) gap &gt; 0.8 kPa, initiation of ECMO was associated with a lower risk for all-cause death (HR 0.43 [95% CI 0.20-0.91]; p = 0.028; NNT 3.5) and the composite endpoint (HR 0.29 [95% CI 0.13-0.62]; p = 0.001). Finally, data regarding SvO(2) were available for 95 patients. In the subgroup with SvO(2) &lt; 60%, initiation of ECMO was associated with lower risk for all-cause mortality (HR 0.34 [95% CI 0.17-0.67]; p = 0.002; NNT 2.8) and the composite endpoint (HR 0.28 [95% CI 0.14-0.57]; p &lt; 0.001). CONCLUSIONS: Measurement of cardiac index, pCO(2) gap and SvO(2) could improve the management of cardiogenic shock. The presence of any of the following criteria - low cardiac index, high pCO(2) gap and low SvO(2) - may indicate a poor prognosis with conservative therapy and a substantial mortality benefit from mechanical circulatory support. TRIAL REGISTRATION: NCT02301819. Retrospectively registered 26 November 2014.

Czech name

—

Czech description

—

Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

<a href="/en/project/NV15-27994A" target="_blank" >NV15-27994A: ExtraCorporeal Membrane Oxygenation in the therapy of Cardiogenic Shock (the ECMO-CS trial)</a><br>

Continuities

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Publication year

2025

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Critical Care

ISSN

1364-8535

e-ISSN

1466-609X

Volume of the periodical

29

Issue of the periodical within the volume

1

Country of publishing house

GB - UNITED KINGDOM

Number of pages

10

Pages from-to

303

UT code for WoS article

001529096100005

EID of the result in the Scopus database

2-s2.0-105010602815