Background:Limited data are available regarding the outcomes of patients supported by extracorporeal membrane oxygenation (ECMO) who undergo durable mechanical circulatory support implantation (dMCS). We analyzed the clinical characteristics, outcomes, and risk factors for mortality in patients who were bridged with ECMO to dMCS.Methods:Adult patients who received dMCS between January 2008 and December 2017 (n=19 824), registered in the Society of Thoracic Surgeons-Interagency Registry for Mechanical Assisted Circulatory Support (STS-INTERMACS) database were included. Baseline characteristics, outcomes, risk factors, and adverse events were compared between ECMO-supported patients (n=933) and INTERMACS profile 1 (IP-1) patients not supported by ECMO (n=2362). A propensity match analysis was performed.Results:ECMO patients had inferior survival at 12 months (66.1%) than non-ECMO patients (75.4%; P<0.0001). The proportion of patients transplanted at 2 years after dMCS was similar between the ECMO (30.8%) and non-ECMO (31.8%) groups (P=0.49). A multiphase parametric hazard model identified 2 different periods based on risk of death. ECMO patients had a high hazard for death in the first 6 months after implantation (hazard ratio, 2.18 [1.79–2.66]; P<0.001). Multivariable analysis showed that ECMO was an independent risk factor associated with poor outcome during the early phase after dMCS (hazard ratio, 1.69 [1.37–2.09]; P<0.0001) but not during the constant phase. ECMO patients had similar outcomes to non-ECMO patients when a propensity matched cohort was analyzed.Conclusions:ECMO-supported patients before dMCS have lower survival compared with other IP-1 patients. A multivariable analysis showed that ECMO is an independent risk factor of poor outcome after dMCS. However, a propensity matched analysis suggested that when important clinical variables are controlled the outcome of both groups is similar. These data support the implantation of dMCS in carefully selected ECMO patients.

中文翻译：

---

体外膜氧合作用作为持久性机械循环支持的桥梁：STS-INTERMACS数据库分析。

背景：关于体外膜氧合作用（ECMO）支持的接受持久性机械循环支持植入术（dMCS）的患者的结局资料尚可。我们分析了将ECMO桥接至dMCS的患者的临床特征，结局和死亡的危险因素。方法：2008年1月至2017年12月之间（n = 19 824）在胸外科医师协会注册的成年患者-包括机构间机械辅助循环支持注册表（STS-INTERMACS）数据库。比较了ECMO支持的患者（n = 933）和不受ECMO支持的INTERMACS profile 1（IP-1）患者（n = 2362）的基线特征，结局，危险因素和不良事件。进行了倾向匹配分析。结果：P <0.0001）。dMCS后2年移植的患者比例在ECMO组（30.8％）和非ECMO组（31.8％）之间是相似的（P = 0.49）。一个多相参数危险模型根据死亡风险确定了两个不同的时期。ECMO患者在植入后的前6个月有很高的死亡危险（危险比为2.18 [1.79-2.66]；P <0.001）。多变量分析显示，ECMO是与dMCS术后早期不良结局相关的独立危险因素（危险比，1.69 [1.37-2.09]；P<0.0001），但不在恒定阶段。分析倾向匹配的队列后，ECMO患者的结局与非ECMO患者相似。结论：dMCS之前ECMO支持的患者生存率较其他IP-1患者低。多变量分析表明，ECMO是dMCS后不良预后的独立危险因素。但是，倾向匹配分析表明，当控制重要的临床变量时，两组的结果相似。这些数据支持在精心挑选的ECMO患者中植入dMCS。