ArticlesVenoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study
Introduction
Sepsis remains a major issue worldwide. In the USA alone, sepsis is responsible for 1·7 million admissions to hospital annually, and has a mortality of 35%–50% when septic shock is present.1, 2 Transient reversible myocardial dysfunction is a common feature during septic shock, affecting 20–65% of patients.3, 4 Although mild decreases in left ventricular ejection fraction (LVEF) combined with left ventricular dilation and a preserved cardiac index appear to be associated with a good survival,3, 4 the mortality of patients with severe myocardial dysfunction and decreased cardiac index might exceed 80%.3, 5, 6 The incidence of this condition in adults is uncertain, but could be up to 24% of patients with septic shock requiring more than 24 h of vasopressors,5 translating to more than 25 000 episodes annually in the USA.1
Use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) during septic shock refractory to conventional treatment remains controversial. Encouraging results in children with survival rates ranging from 50% to 75%,7, 8 led to the inclusion of this therapeutic option in recent paediatric guidelines of septic shock,8 whereas data in adults have been more equivocal.9, 10, 11, 12, 13, 14 In this study, we aimed to assess the use of VA-ECMO in adults with sepsis-induced cardiogenic shock refractory to conventional treatments.
Section snippets
Study design
In this retrospective, international, multicentre study we compared outcomes of patients who received VA-ECMO for refractory sepsis-induced cardiogenic shock with patients who did not. Data for patients with ECMO were obtained from databases of five university hospital ECMO centres (La Pitié-Salpêtrière, Paris, Amiens, Nancy, and Rennes University Hospitals, France; and Columbia University Medical Centre/New York-Presbyterian Hospital, New York, NY, USA). Data for patients with severe septic
Results
82 patients who received VA-ECMO for sepsis-induced cardiogenic shock were included in the analysis. Baseline characteristics are given in table 1. Community-acquired pneumonia accounted for the largest proportion of infections. 44 (54%) of 82 patients had sustained bacteraemia. Staphylococcus aureus and Streptococcus pneumonia, gram-negative bacteria, and non-pneumococcal streptococci were responsible for 26 (32%), 20 (24%), 24 (29%), and 12 (15%) of 82 episodes, respectively.
ECMO was used
Discussion
Our major finding is that the 90-day survival of patients treated with VA-ECMO was substantially improved compared with propensity-weighted patients with similar characteristics who were treated with medical management alone. VA-ECMO permitted a rapid decrease in vasopressor dose, and restored adequate perfusion of vital organs, as indicated by relatively rapid decreases in serum lactate. Improvement of cardiac function was also relatively quick and permitted weaning of ECMO support after a
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