Modifiable Mechanical Ventilation Targets Are Associated With Improved Survival in Ventilated VA-ECLS Patients

Rali, AS; Tran, LE; Auvil, B; Xu, M; Huang, S; Labrada, L; Schlendorf, KH; Bacchetta, MD; Shah, AS; Hernandez, A; Lindenfeld, J

doi:10.1016/j.jchf.2023.03.023

Acute cardiac care & resuscitation

Modifiable Mechanical Ventilation Targets Are Associated With Improved Survival in Ventilated Venoarterial Extracorporeal Life Support (VA-ECLS) Patients

JACC Heart FailPublished 10 May 2023Retrospective registry cohort study

Main finding · Survival to dischargeResultAdjusted odds ratio 1.69 95% CI 1.21–2.37

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Authors' conclusion

LPPV is associated with improved outcomes in CS patients on VA-ECLS requiring MV.

Study context

Population: Patients with cardiogenic shock on VA-ECLS and mechanical ventilation, ELSO registry, 2009–2019
Participants: 2,226 patients

Exposure: LPPV vs no LPPV
LPPVn = 1,904
Outcome: Survival to discharge

Methodological detailsmultivariable-adjusted

Multivariable-adjusted

Main finding

As reported in the abstract

Adjusted odds ratio

1.69

95% CI 1.21–2.37

P = 0.0021

By group

LPPV47.4%

no-LPPV32.6%

LPPVvs no-LPPV

adjusted OR 1.69 (95% CI 1.21–2.37); P = 0.0021

Observational data: associations, not effects.

Further findings

Ventilator pressures at 24 h, survivors to discharge vs non-survivors

Median peak inspiratory pressure lower in survivors: 22 vs 24 cm H2O: P < 0.001
Median dynamic driving pressure (DDP) lower in survivors: 14.5 vs 16 cm H2O: P < 0.001

Original publication

Modifiable Mechanical Ventilation Targets Are Associated With Improved Survival in Ventilated VA-ECLS Patients. JACC Heart Fail. Published 10 May 2023. doi:10.1016/j.jchf.2023.03.023

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