title: Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: An observational study and propensity-score analysis.
abstract: Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock.
  
  
  
  Using a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients.
  
  
  
  Among 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD=15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P=0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival=0.9, 95%CI 0.4-2.3, P=0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR=1.7 per 0.1 increase, 95%CI 1.0-2.8, P=0.04) and implantation of VA-ECMO over 24h after ROSC (OR=20.0, 95%CI 1.4-277.3, P=0.03) were associated with survival.
  
  
  
  Post-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.
authors.affiliation: Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France.
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Medical ICU, Pompidou Hospital, APHP, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.affiliation: Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.affiliation: Medical ICU, Lariboisière Hospital, AP-HP, Paris, France; INSERM U942, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; ICU and SAMU 75, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Paris Sudden-Death-Expertise-Center, Paris, France; Paris Fire Brigade Emergency Dept., Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jost
authors.affiliation: Cardiology Department, Pitié-Salpétrière Hospital, APHP, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Maupain
authors.affiliation: Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France.
authors.forename: Frankie
authors.initials: F
authors.lastname: Beganton
authors.affiliation: Human Histopathology and Animal Models Unit, Infection and Epidemiology Department, Institut Pasteur, Paris, France; Anesthesiology and Intensive Care, Institut de Cardiologie, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Bouglé
authors.affiliation: Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.affiliation: Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Medical ICU, Cochin Hospital, AP-HP, Paris, France. Electronic address: alain.cariou@cch.aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D012042:Registries / Q000706:statistics & numerical data; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy
keywords: Cardiac arrest; Extracorporeal life support; Shock