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

Kód výsledku v 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>

Nalezeny alternativní kódy

RIV/00216208:11110/25:10499634 RIV/00216208:11130/25:10499634 RIV/00216208:11140/25:10499634 RIV/00064203:_____/25:10499634 a 2 dalších

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

<a href="/cs/project/NV15-27994A" target="_blank" >NV15-27994A: Extrakorporální membránová oxygenace v léčbě kardiogenního šoku (studie ECMO-CS)</a><br>

Návaznosti

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

Rok uplatnění

2025

Kód důvěrnosti údajů

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

Název periodika

Critical Care

ISSN

1364-8535

e-ISSN

1466-609X

Svazek periodika

29

Číslo periodika v rámci svazku

1

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

10

Strana od-do

303

Kód UT WoS článku

001529096100005

EID výsledku v databázi Scopus

2-s2.0-105010602815