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Master Thesis

Évaluation de l’oxygénation extra-corporelle veino-artérielle dans le traitement du choc cardiogénique post-cardiotomie : une étude rétrospective avec score de propension

Abstract : Post-cardiotomy cardiogenic shock (PCCS) is a threatening complication. In the case of refractory PCCS, circulatory support may be the only way to save patient life. Veino-arterial extra-corporeal membrane oxygenation (ECMO) provides blood oxygenation and circulatory support. We aimed to investigate ECMO support in refractory PCCS and whether early initiation of ECMO could improve post-operative outcomes.
Methods: all patients with serious PCCS between January 2016 and December 2018 were included. Propensity score analysis was used to compare outcomes of delayed and early initiation of ECMO after refractory PCCS.
Results: among 238 patients who experienced serious PCCS, 78 had died (32.8%). In multivariate analysis, epinephrine use (OR = 3.84 [1.66-9.26]), vasoactive inotropic score > 20 (OR = 2.41 [1.01-6.04]) and prolonged cardiopulmonary bypass assistance (OR = 2.45 [1.13 - 5.46]) were independently associated with death. Of the 102 patients (42.9%) supported with ECMO, 34 (33.3%) were alive at hospital discharge. After propensity score matching, 25 patients in the early ECMO initiation group and 25 in the delayed ECMO initiation group were identified. Early strategy was associated with lower renal replacement therapy (RTT) rate (60% versus 84%, p = 0.003) and non-significant mortality rate reduction (60% vesrus 84%, p = 0.115).
Conclusion: serious PCCS is associated with high mortality rate. Compared to a delayed strategy, early initiation of ECMO may improve tissue perfusion and was associated with lower RTT rate.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03366646
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Submitted on : Tuesday, October 5, 2021 - 5:30:44 PM
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  • HAL Id : dumas-03366646, version 1

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Louis Morisson. Évaluation de l’oxygénation extra-corporelle veino-artérielle dans le traitement du choc cardiogénique post-cardiotomie : une étude rétrospective avec score de propension. Médecine humaine et pathologie. 2019. ⟨dumas-03366646⟩

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