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Association of Prophylactic Distal Perfusion Cannulation With Mortality in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation
- Title
- Association of Prophylactic Distal Perfusion Cannulation With Mortality in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation
- Authors
- Lee; Hyeok-Hee; Jang; Woo Jin; Ahn; Chul-Min; Chun; Woo Jung; Oh; Ju Hyeon; Park; Yong Hwan; Seung-Jun; Hong; Sung-Jin; Yang; Jeong Hoon; Kim; Jung-Sun; Hyeon Chang; Byeong-Keuk; Yu; Cheol Woong; Hyun-Joong; Bae; Jang-Whan; Ko; Young-Guk; Choi; Donghoon; Gwon; Hyeon-Cheol; Myeong-Ki; Yangsoo
- Ewha Authors
- 장우진
- SCOPUS Author ID
- 장우진
- Issue Date
- 2023
- Journal Title
- American Journal of Cardiology
- ISSN
- 0002-9149
- Citation
- American Journal of Cardiology vol. 207, pp. 418 - 425
- Keywords
- distal perfusion; extracorporeal membrane oxygenation; mortality; prophylaxis
- Publisher
- Elsevier Inc.
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- Prophylactic distal perfusion cannulation (PDPC) is protectively associated with limb ischemia in patients with cardiogenic shock (CS) receiving femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, evidence supporting its benefits beyond limb ischemia reduction is scarce. We aimed to investigate whether PDPC, compared with no-PDPC, is associated with a lower risk of mortality in patients receiving VA-ECMO. From a multicenter registry, we identified 479 patients who underwent VA-ECMO support for refractory CS. The association of PDPC with 30-day mortality was assessed using multiple methods, including instrumental variable analysis, overlap weighting, and propensity score matching. Of the 479 patients, 154 (32.2%) received PDPC. The 30-day mortality rate was 33.1% in the PDPC group and 53.2% in the no-PDPC group. The instrumental variable analysis showed a protective association of PDPC with 30-day mortality (absolute risk difference −16.7%, 95% confidence interval −31.3% to −2.1%; relative risk 0.68, 95% confidence interval 0.40 to 0.96). The findings were consistent in the overlap-weighted analysis (hazard ratio 0.68, 95% confidence interval 0.48 to 0.98) and in the propensity score–matched analysis (hazard ratio 0.67, 95% confidence interval 0.45 to 1.00). There were no significant differences in safety outcomes, including stroke, ECMO site bleeding, gastrointestinal bleeding, and sepsis, between PDPC and no-PDPC. In conclusion, PDPC was associated with a lower risk of mortality at 30 days in patients with CS receiving VA-ECMO. The efficacy and safety of PDPC merit evaluation in future randomized studies. Clinical trial registration: ClinicalTrials.gov; NCT02985008. © 2023 Elsevier Inc.
- DOI
- 10.1016/j.amjcard.2023.07.149
- Appears in Collections:
- 의료원 > 의료원 > Journal papers
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