Optimal ECLS Support in Mixed Cardiogenic and Septic Shock: An ELSO Registry Analysis.

Area of Science:

• Cardiovascular Medicine
• Critical Care Medicine
• Shock Pathophysiology

Background:

• Mixed cardiogenic and septic shock presents a higher mortality risk compared to cardiogenic shock alone.
• This complex shock state exhibits a distinct hemodynamic profile requiring specialized management.

Purpose of the Study:

• To investigate the association between the level of circulatory support provided by veno-arterial extracorporeal life support (VA-ECLS) and survival outcomes in patients with mixed shock.
• To determine if higher VA-ECLS flow rates correlate with improved survival to discharge.

Main Methods:

• Utilized the Extracorporeal Life Support Organization (ELSO) registry to identify adult patients diagnosed with mixed (cardiogenic and septic) shock.
• Patients requiring VA-ECLS between 2017 and 2022 were categorized based on circulatory support levels at 24 hours post-initiation: lower (<2.2 L/min/m²) versus higher (≥2.2 L/min/m²).

Main Results:

• A total of 452 patients with mixed shock on VA-ECLS were analyzed, with an overall mortality rate of 63%.
• Factors associated with increased mortality included older age, pre-VA-ECLS cardiac arrest, and higher Charlson Comorbidity Index.
• Patients receiving higher VA-ECLS support demonstrated a numerical trend towards improved survival to discharge (42.6% vs. 33.8%, P=0.063).

Conclusions:

• Mixed shock patients requiring VA-ECLS face a substantial risk of mortality.
• Higher levels of VA-ECLS support at 24 hours post-initiation may be associated with a trend towards better survival, warranting further investigation.
• These findings are hypothesis-generating and underscore the need for additional research to optimize VA-ECLS strategies in mixed shock.