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

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Alarfaj, Mohammad
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Tran, Lena
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Granger, Hannah
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Hernandez, Antonio
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Hu, Jinxiang
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Baker, Jordan
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Grandin, Edward W.
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Delgado, Alvaro A.
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Katz, Jason N.
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Genre
Journal article
Date
2025-10
Advisor
Committee member
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Temple University. Hospital
Department
Cardiovascular Sciences
Subject
ECLS flow
 ELSO registry
 Mixed shock
 Outcomes
 VA-ECLS
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https://scholarshare.temple.edu/handle/20.500.12613/11383
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Open Access Publishing Fund
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Labrada-Journal Article-2025-10.pdf
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DOI
https://doi.org/10.1016/j.jacadv.2025.101965
Abstract
Background Mixed cardiogenic and septic shock has been shown to have a higher mortality than cardiogenic shock alone and presents a unique hemodynamic phenotype. Objectives This study aimed to evaluate whether higher circulatory support with veno-arterial extracorporeal life support (VA-ECLS) was associated with increased survival to discharge in patients with mixed shock. Methods We queried the Extracorporeal Life Support Organization database to identify adult (age >18 years) patients in mixed (cardiogenic and septic) shock requiring VA-ECLS between 2017 and 2022. Patients were categorized into lower (<2.2 L/min/m2 flow) or higher (≥2.2 L/min/m2 flow) circulatory support on VA-ECLS at 24 hours post-ECLS initiation. Results A total of 452 patients supported with VA-ECLS with mixed shock were identified. Overall mortality was 63% (n = 285). Older age (adjusted OR [aOR]: 1.02; 95% CI: 1.01-1.04; P < 0.001), pre-extracorporeal membrane oxygenation cardiac arrest (aOR: 1.71; 95% CI: 1.11-2.65; P = 0.016), and baseline Charlson Comorbidity Index (aOR: 1.13; 95% CI: 1.01-1.28; P = 0.043) were associated with increased mortality. Patients receiving higher VA-ECLS support at 24 hours were numerically more likely to survive to discharge (42.6% vs 33.8%, P = 0.063). When evaluated as a continuous variable, higher VA-ECLS flow at 24 hours was associated with an aOR of 1.31 (95% CI: 0.87-1.97; P = 0.19) for survival to discharge. Conclusions Patients with mixed shock requiring VA-ECLS have a high mortality. Patients with mixed shock receiving higher support at 24 hours had a trend toward increased survival to discharge compared to those with lower support. These results are hypothesis-generating, and further studies are needed.
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Citation
Lyana Labrada, Mohammad Alarfaj, Lena Tran, Hannah Granger, Antonio Hernandez, Jinxiang Hu, Jordan Baker, Edward W. Grandin, Alvaro A. Delgado, Jason N. Katz, P. Elliott Miller, Carlos L. Alviar, Erik Osborn, Matthew D. Bacchetta, JoAnn Lindenfeld, Zubair Shah, Aniket S. Rali, Optimal ECLS Support in Mixed Cardiogenic and Septic Shock: An ELSO Registry Analysis, JACC: Advances, Volume 4, Issue 10, Part 1, 2025, 101965, ISSN 2772-963X, https://doi.org/10.1016/j.jacadv.2025.101965.
Citation to related work
Elsevier
Has part
JACC: Advances, Vol. 4, Iss. 10
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