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04-03-2024 | ECMO | Original

Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis

Authors: Quentin Moyon, Félicien Triboulet, Jean Reuter, Guillaume Lebreton, Amandine Dorget, Marylou Para, Juliette Chommeloux, Jules Stern, Marc Pineton de Chambrun, Guillaume Hékimian, Charles-Edouard Luyt, Alain Combes, Romain Sonneville, Matthieu Schmidt

Published in: Intensive Care Medicine | Issue 3/2024

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.

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Title: Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis
Authors: Quentin Moyon
Félicien Triboulet
Jean Reuter
Guillaume Lebreton
Amandine Dorget
Marylou Para
Juliette Chommeloux
Jules Stern
Marc Pineton de Chambrun
Guillaume Hékimian
Charles-Edouard Luyt
Alain Combes
Romain Sonneville
Matthieu Schmidt
Publication date: 04-03-2024
Publisher: Springer Berlin Heidelberg
Keywords: ECMO
ECMO
Cardiogenic Shock
Cardiogenic Shock
Published in: Intensive Care Medicine / Issue 3/2024
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-024-07354-2

2024 ASCO Annual Meeting

Springer Medicine

Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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