TOPLINE

Among patients with cardiogenic shock who survived the first 24 hours of support with venoarterial (VA) extracorporeal membrane oxygenation (ECMO), higher pulmonary artery diastolic (PAD) pressure was associated with greater risk for in-hospital mortality. Hemodynamic monitoring using pulmonary arterial catheter (PAC) was not associated with better survival.

METHODOLOGY

• Researchers analyzed data from the ELSO registry to assess whether the hemodynamic monitoring using PAC and early PAD pressure were linked to survival in 7654 adults who received VA ECMO for cardiogenic shock between 2015 and 2020.
• Overall, 3077 patients who survived to 24 hours of ECMO had a PAC in place and were compared with propensity-matched patients without a PAC. 
• A subset of 2711 patients was included in the PAD pressure analysis (pulmonary capillary wedge pressure was used in some).
• PAD pressure was measured at 24 hours, categorized into quartiles, and also assessed as ≤ 18 mm Hg vs > 18 mm Hg. Researchers also assessed whether left ventricular unloading devices influenced the results.
• The primary outcome was in-hospital mortality within 30 days of starting ECMO. Results were adjusted for measures such as age, severity of shock, and cardiac arrest before ECMO.

TAKEAWAY

• Having a PAC while being on VA ECMO support was not associated with a significant difference in survival.
• Among patients with a PAC who survived to 24 hours, those with a PAD pressure above 18 mm Hg had a 29% higher risk for in-hospital mortality within 30 days than those with a PAD pressure at or below 18 mm Hg (P < .001). 
• Higher PAD was also associated with progressively greater risk for mortality when analyzed in quartiles and when modeled continuously.
• Concomitant unloading with an intra-aortic balloon pump or peripherally inserted ventricular assist device was not significantly associated with improved survival vs ECMO alone. Higher PAD remained associated with elevated risk for death in patients with these devices.

IN PRACTICE

"Acknowledging the potential for confounding by indication and bias in PAC placement, these findings may provide a framework for hemodynamic targets during VA ECMO support and could help guide future studies of concomitant LVMU [left ventricular mechanical unloading] devices," the researchers wrote.

SOURCE

The study was led by Joseph E. Tonna, MD, MS, of the University of Utah Health in Salt Lake City. It was published online on October 5 in JACC: Heart Failure.

LIMITATIONS

Researchers used PAD pressure as a proxy for left-heart filling pressures. They relied on registry data and did not have a separate external dataset for validation. The study included only one hemodynamic measurement at 24 hours.

DISCLOSURES

The study received support from the National Center for Research Resources and the National Center for Advancing Translational Sciences. One author reported receiving support from the National Heart, Lung, and Blood Institute. Another author reported receiving consulting fees from three companies. One author is employed by J&J Med Tech (which did not have a role in the study) and reported receiving funding and consulting or speaking honoraria from several companies in the past 2 years. Detailed disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.