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 (1) , Christophe Beyls (2) , Antoine Lamer (1, 3) , Stefan Roksic , Francis Juthier , Guillaume Leroy , Vincent Petitgand , Natacha Rousse (4) , Christophe Decoene , Céline Dupré , Thierry Caus (2, 5) , Pierre Huette (6) , Mathieu Guilbart (2) , Pierre-Grégoire Guinot (7) , Patricia Besserve (8) , Yazine Mahjoub (2, 9) , Hervé Dupont (9) , Emmanuel Robin (10) , Jonathan Meynier (11) , André Vincentelli (1) , Osama Abou-Arab (2)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 CHU Amiens-Picardie
3 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
4 Institut Coeur Poumon [CHU Lille]
5 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
6 Département d'anesthésiologie [CHU Caen]
7 CHU Dijon
8 Anesthésie réanimation et Médecine d'urgence
9 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
10 CP2M - Catalyse, Polymérisation, Procédés et Matériaux
11 Direction de la recherche clinique et de l'innovation [CHU Amiens]

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 (PaO(2)) variables were recorded for 48 h following admission: the absolute peak PaO(2) (the single highest value measured during the 48~h), the mean daily peak PaO(2) (the mean of each day's peak values), the overall mean PaO(2) (the mean of all values over 48~h), and the severity of hyperoxia (mild: PaO(2)\,<\,200~mmHg, moderate: PaO(2)\,=\,200-299~mmHg, severe: PaO(2)\,≥q\,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 PaO(2) values were significantly higher in non-survivors than in survivors. In a multivariate logistic regression analysis, the mean daily peak PaO(2), absolute peak PaO(2), and overall mean PaO(2) 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.

Mots clés: *Extracorporeal Membrane Oxygenation; *Hyperoxia; Adult; Cardiogenic shock; ECMO; Humans; Hyperoxia; Mortality; Oxygen; Propensity Score; Retrospective Studies; Shock; Cardiogenic

Domaines: Médecine humaine et pathologie

Mouhamed Djahoum Moussa, Christophe Beyls, Antoine Lamer, Stefan Roksic, Francis Juthier, et al.. Early Hyperoxia and 28-Day Mortality in Patients on Venoarterial ECMO Support for Refractory Cardiogenic Shock: A Bicenter Retrospective Propensity Score-Weighted Analysis.. Critical Care, 2022, 26 (1), pp.257. ⟨10.1186/s13054-022-04133-7⟩. ⟨hal-03767979⟩