Early hyperoxia and 28-day mortality in patients on venoarterial ECMO support for refractory cardiogenic shock: a bicenter retrospective propensity score-weighted analysis
Mouhamed Djahoum Moussa,
Christophe Beyls,
Antoine Lamer,
Stefan Roksic,
Francis Juthier,
Guillaume Leroy,
Vincent Petitgand,
Natacha Rousse,
Christophe Decoene,
Céline Dupré,
Thierry Caus,
Pierre Huette,
Mathieu Guilbart,
Pierre-Grégoire Guinot,
Patricia Besserve,
Yazine Mahjoub,
Hervé Dupont,
Emmanuel Robin,
Jonathan Meynier,
André Vincentelli,
Osama Abou-Arab
Affiliations
Mouhamed Djahoum Moussa
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Christophe Beyls
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Antoine Lamer
CHU Lille, ULR 2694-METRICS : Évaluation des Technologies de Santé Et des Pratiques Médicales
Stefan Roksic
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Francis Juthier
Cardiac Surgery, Lille Hospital University
Guillaume Leroy
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Vincent Petitgand
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Natacha Rousse
Cardiac Surgery, Lille Hospital University
Christophe Decoene
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Céline Dupré
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Thierry Caus
Cardiac Surgery, Amiens University Medical Center
Pierre Huette
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Mathieu Guilbart
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Pierre-Grégoire Guinot
Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital
Patricia Besserve
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Yazine Mahjoub
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Hervé Dupont
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Emmanuel Robin
Pôle d’Anesthésie-Réanimation, Lille Hospital University
Jonathan Meynier
Department of Biostatistics, Amiens Picardy University Hospital
André Vincentelli
Cardiac Surgery, Lille Hospital University
Osama Abou-Arab
Anesthesia and Critical Care Medicine Department, Amiens University Medical Center
Abstract Background The mortality rate for a patient with a refractory cardiogenic shock on venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains high, and hyperoxia might worsen this prognosis. The objective of the present study was to evaluate the association between hyperoxia and 28-day mortality in this setting. Methods We conducted a retrospective bicenter study in two French academic centers. The study population comprised adult patients admitted for refractory cardiogenic shock. The following arterial partial pressure of oxygen (PaO2) variables were recorded for 48 h following admission: the absolute peak PaO2 (the single highest value measured during the 48 h), the mean daily peak PaO2 (the mean of each day’s peak values), the overall mean PaO2 (the mean of all values over 48 h), and the severity of hyperoxia (mild: PaO2 < 200 mmHg, moderate: PaO2 = 200–299 mmHg, severe: PaO2 ≥ 300 mmHg). The main outcome was the 28-day all-cause mortality. Inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in baseline characteristics. Results From January 2013 to January 2020, 430 patients were included and assessed. The 28-day mortality rate was 43%. The mean daily peak, absolute peak, and overall mean PaO2 values were significantly higher in non-survivors than in survivors. In a multivariate logistic regression analysis, the mean daily peak PaO2, absolute peak PaO2, and overall mean PaO2 were independent predictors of 28-day mortality (adjusted odds ratio [95% confidence interval per 10 mmHg increment: 2.65 [1.79–6.07], 2.36 [1.67–4.82], and 2.85 [1.12–7.37], respectively). After IPW, high level of oxygen remained significantly associated with 28-day mortality (OR = 1.41 [1.01–2.08]; P = 0.041). Conclusions High oxygen levels were associated with 28-day mortality in patients on VA-ECMO support for refractory cardiogenic shock. Our results confirm the need for large randomized controlled trials on this topic.
