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Levy B, Girerd N, Duarte K, Antoine ML, Monzo L, Alexandre O, Clément D, Brodie D, Combes A, Kimmoun A, Baudry G. Hypothermia in patients with cardiac arrest prior to ECMO-VA: Insight from the HYPO-ECMO trial. Resuscitation 2024:110235. [PMID: 38762081 DOI: 10.1016/j.resuscitation.2024.110235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
AIM Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become a common intervention for patients with cardiogenic shock (CS), often complicated by cardiac arrest (CA). Moderate hypothermia (MH) has shown promise in mitigating ischemia-reperfusion injury following CA. The HYPO-ECMO trial aimed to compare the effect of MH versus normothermia in refractory CS rescued by VA-ECMO. The primary aim of this non-predefined post hoc study was to assess the treatment effect of MH in the subgroup of patients with cardiac arrest (CA) within the HYPO-ECMO trial. Additionally, we will evaluate the prognostic significance of CA in these patients. METHODS This post hoc analysis utilized data from the randomized HYPO-ECMO trial conducted across 20 French cardiac shock care centers between October 2016 and July 2019. Participants included intubated patients receiving VA-ECMO for CS for less than 6 hours, with 334 patients completing the trial. Patients were randomized to early MH (33-34°C) or normothermia (36-37°C) for 24 hours. RESULTS Of the 334 patients, 159 (48%) experienced preceding CA. Mortality in the CA group was 50.9% at 30 days and 59.1% at 180 days, compared to 42.3% and 51.4% in the no-CA group, respectively (adjusted risk difference [RD] at 30 days, 8.1% [-0.8 to 17.1%], p=0.074 and RD at 180 days 7.0% [-3.0 to 16.9%], p=0.17). MH was associated with a significant reduction in primary (RD -13.3% [-16.3 to -0.3%], p=0.031) and secondary outcomes in the CA group only (p<0.025 for all), with a significant interaction between MH and CA status for 180-day mortality [p=0.03]. CONCLUSIONS This post hoc analysis suggests that MH shows potential for reducing mortality and composite endpoints in patients with cardiac arrest and refractory CS treated with VA-ECMO without an increased risk of severe bleeding or infection. Further research is needed to validate these findings and elucidate underlying mechanisms.
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Affiliation(s)
- Bruno Levy
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy France, Université de Lorraine, Nancy, France.
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances, INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Kevin Duarte
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances, INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Marie-Lauren Antoine
- Centre Régional de Pharmacovigilance de Nancy, Vigilance des Essais Cliniques - CHRU Nancy-Brabois
| | - Luca Monzo
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances, INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Ouattara Alexandre
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France, University Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Delmas Clément
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France; REICATRA, Université de Lorraine, Nancy, France
| | - Daniel Brodie
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
| | - Antoine Kimmoun
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy France, Université de Lorraine, Nancy, France
| | - Guillaume Baudry
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances, INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France; REICATRA, Université de Lorraine, Nancy, France
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Henry J, Fresse A, Beurrier M, Antoine ML, Gillet P. Profile of adverse drug reactions reported via the Continuum+ platform: Results from three-year regional follow-up. Therapie 2024:S0040-5957(24)00042-8. [PMID: 38658232 DOI: 10.1016/j.therap.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
In 2017, the Continuum+ platform was launched to provide a monitoring solution to home-based cancer care patients: AKO@dom monitoring. This platform also offers the follow-up of adverse drug reactions (ADRs) via direct notification to regional centers of pharmacovigilance (RCPVs). According to previous studies, the AKO@dom monitoring has successfully maintained treatment at the maximum effective dosage, managing ADRs and patient satisfaction. However, on the pharmacovigilance side, opinions are more divided. Due to the launch of the AKO@dom-PICTO experimentation in December 2021, in which our RCPV takes part, and to provide more data on pharmacovigilance, we decided to conduct a descriptive analysis of cases reported to our RCPV via the Continuum+ platform between 2019 and 2022. During these three years, we analyzed 1070 events, corresponding to 37 patients. Patients were primarily women (74.8%) aged around seventy with breast cancer. The most used drugs were tyrosine kinase inhibitors: palbociclib (29.7%), axitinib (16.2%), and cabozantinib (13.2%). Patients had an average of 8 ADRs, including one serious and/or unexpected ADR. Although the Continuum+ platform makes it possible to considerably limit under-reporting in pharmacovigilance, it has shortcomings. The lack of medical elements and context in notifications is a massive problem for analyzing pharmacovigilance reports. Improved access to the platform's medical information for RCPVs and pharmacovigilance training for healthcare professionals would make Continuum+ a helpful tool in pharmacovigilance.
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Affiliation(s)
- Juliette Henry
- Centre régional de pharmacovigilance, laboratoire de pharmacologie-toxicologie et centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance de Nancy, centre hospitalier régional et universitaire de Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Audrey Fresse
- Centre régional de pharmacovigilance, laboratoire de pharmacologie-toxicologie et centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance de Nancy, centre hospitalier régional et universitaire de Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Mathilde Beurrier
- Centre régional de pharmacovigilance, laboratoire de pharmacologie-toxicologie et centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance de Nancy, centre hospitalier régional et universitaire de Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Marie-Lauren Antoine
- Centre régional de pharmacovigilance, laboratoire de pharmacologie-toxicologie et centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance de Nancy, centre hospitalier régional et universitaire de Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France; Clinical Trial Vigilance Unit, Nancy Regional University Hospital Center, 54511 Vandœuvre-lès-Nancy, France
| | - Pierre Gillet
- Centre régional de pharmacovigilance, laboratoire de pharmacologie-toxicologie et centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance de Nancy, centre hospitalier régional et universitaire de Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France; Centre national de la recherche scientifique, IMOPA, université de Lorraine, 54000 Nancy, France
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