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The Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients: An Analysis Using a Nationwide Inpatient Database

Aso, Shotaro MD, MPH; Matsui, Hiroki MPH; Fushimi, Kiyohide MD, PhD; Yasunaga, Hideo MD, PhD

doi: 10.1097/CCM.0000000000001828
Clinical Investigations
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Objectives: The role of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients remains unknown. This study investigated the effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation on reducing mortality of cardiogenic shock patients.

Design: Retrospective cohort study.

Setting: The Japanese Diagnosis Procedure Combination national inpatient database.

Patients: Cardiogenic shock adult patients receiving peripheral venoarterial extracorporeal membrane oxygenation at admission were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2013.

Interventions: None.

Measurements and Main Results: The primary outcomes were all-cause 28-day mortality and in-hospital mortality, and the secondary outcome was the proportion of patients weaned from venoarterial extracorporeal membrane oxygenation, using propensity score matching. Eligible patients (n = 1,650) were divided into the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group (n = 604) and the venoarterial extracorporeal membrane oxygenation–alone group (n = 1,064). Propensity score matching created matched cohort of 533 pairs. In the propensity score–matched analysis, all-cause 28-day mortality and in-hospital mortality were significantly lower in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than the venoarterial extracorporeal membrane oxygenation–alone group (48.4% vs 58.2%; p = 0.001 and 55.9% vs 64.5%; p = 0.004, respectively). In Cox regression, there was a significant difference in survival between the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group and the venoarterial extracorporeal membrane oxygenation–alone group (hazard ratio, 0.74; 95% CI, 0.63–0.86; p < 0.001). The proportion of patients weaned from venoarterial extracorporeal membrane oxygenation was significantly higher in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than in the venoarterial extracorporeal membrane oxygenation–alone group (82.6% vs 73.4%; p < 0.001).

Conclusions: In a national inpatient database, intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation was associated with improved mortality and successful weaning from venoarterial extracorporeal membrane oxygenation. Randomized controlled studies are required to confirm the mortality-reducing effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation.

1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

2Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

Supported, in part, by grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (grant numbers: H27-Policy-Designated-009 and H27-Policy-Strategy-011). The funders had no role in the execution of this study or interpretation of the results.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: asou-sin@umin.ac.jp

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