Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

Lasarte, M. Rivas; Sans‐Roselló, Jordi; Vilà, Montserrat; Tolppanen, Heli; Lassus, Johan; Lindholm, Matias Greve; Mebazaa, Alexandre; Harjola, Veli‐Pekka; Sionís, Alessandro

doi:10.1177/0885066619828959

Cited by 57 publications

(49 citation statements)

References 28 publications

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“…43,44 Rossello et al 16 showed the use of PAC to be associated with lower mortality in CS from non-AMI aetiology, but no differences in those with AMI-CS. In a subgroup analysis of the CardShock study, Sionis et al 17 noted the use of a PAC to be associated with greater use of aggressive therapies (including inotropes) but without any differences in in-hospital mortality. This study noted a declining trend in the use of PAC in AMI-CS, which is in contrast to similar studies from patients with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

et al. 2020

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Aims The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction-cardiogenic shock (AMI-CS). Methods and results A retrospective cohort of AMI-CS admissions using the National Inpatient Sample (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) was identified. Admissions with concomitant cardiac surgery or non-AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in-hospital mortality, resource utilization, and temporal trends in cohorts with and without PAC use. In the non-PAC cohort, the use and outcomes of right heart catheterization was evaluated. Multivariable regression and propensity matching was used to adjust for confounding. During 2000-2014, 364 001 admissions with AMI-CS were included. PAC was used in 8.1% with a 75% decrease during over the study period (13.9% to 5.4%). Greater proportion of admissions to urban teaching hospitals received PACs (9.5%) compared with urban non-teaching (7.1%) and rural hospitals (5.4%); P < 0.001. Younger age, male sex, white race, higher comorbidity, noncardiac organ failure, use of mechanical circulatory support, and noncardiac support were independent predictors of PAC use. The PAC cohort had higher in-hospital mortality (adjusted odds ratio 1.07 [95% confidence interval 1.04-1.10]), longer length of stay (10.9 ± 10.9 vs. 8.2 ± 9.3 days), higher hospitalization costs ($128 247 ± 138 181 vs. $96 509 ± 116 060), and lesser discharges to home (36.3% vs. 46.4%) (all P < 0.001). In 6200 propensity-matched pairs, in-hospital mortality was comparable between the two cohorts (odds ratio 1.01 [95% confidence interval 0.94-1.08]). Right heart catheterization was used in 12.5% of non-PAC admissions and was a marker of greater severity but did not indicate worse outcomes. Conclusions In AMI-CS, there was a 75% decrease in PAC use between 2000 and 2014. Admissions receiving a PAC were a higher risk cohort with worse clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

et al. 2020

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“…The product of these combined parameters is the cardiac power (CP), and is the strongest haemodynamic predictor of mortality in the SHOCK trial registry [7]. This finding was confirmed in a more recent study, where the cardiac power index (CPI) was found to be the best haemodynamic predictor of survival in a CS population [8].…”

Section: Introductionmentioning

confidence: 69%

“…When comparing the different Impella devices, the Impella 2.5 in general achieves a lower performance relative to the Impella 5.0 in both CP (+48% vs +82%) and CPI (+58% vs +102%). The observed increase in CP(I) during Impella support, which has been shown to be a strong haemodynamic predictor of survival in CS [7,8], should theoretically lead to a reduction in mortality. Extrapolating from the survival graph of Fincke et al, the increase of CP from 0.5 W to 0.9 W should decrease mortality from approximately 50% to 20% [7].…”

Section: Discussionmentioning

confidence: 92%

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

et al. 2019

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The Impella percutaneous mechanical circulatory support device is designed to augment cardiac output and reduce left ventricular wall stress and aims to improve survival in cases of cardiogenic shock. In this meta-analysis we investigated the haemodynamic effects of the Impella device in a clinical setting. We systematically searched all articles in PubMed/ Medline and Embase up to July 2019. The primary outcomes were cardiac power (CP) and cardiac power index (CPI). Survival rates and other haemodynamic data were included as secondary outcomes. For the critical appraisal, we used a modified version of the U.S. Department of Health and Human Services quality assessment form. The systematic review included 12 studies with a total of 596 patients. In 258 patients the CP and/or CPI could be extracted. Our meta-anal-D.I.M. van Dort and K.R.A.H. Peij contributed equally to this manuscript. ysis showed an increase of 0.39 W [95% confidence interval (CI): 0.24, 0.54], (p = 0.01) and 0.22 W/m 2 (95% CI: 0.18, 0.26), (p < 0.01) for the CP and CPI, respectively. The overall survival rate was 56% (95% CI: 0.50, 0.62), (p = 0.09). The quality of the studies was moderate, mostly due to the presence of confounders. Our study suggests that in patients with cardiogenic shock, Impella support seems effective in augmenting CP(I). This study merely investigates the haemodynamic effectiveness of the Impella device and does not reflect the complete clinical impact for the patient. Review Article ConclusionOur meta-analysis shows that short-term MCS with the Impella device is effective in increasing CP and CPI. Despite successfully increased CP with Impella support, the mortality seems to be in line with the survival rate without Impella use.

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“…Remarkably, RHC was used intentionally to optimize pharmacological treatment, not only for those that did not prove any benefit; additionally, it was associated with a higher risk of adverse events, predominantly PAC infection [85]. Sionis [86] and co-workers analyzed the data of cardiogenic shock (CS) patients included in the CardShock registry. Eighty-two of them (37.4%) diagnosed with PAC received goal-oriented therapy consisting of mechanical ventilation, renal replacement therapy, and mechanical assist devices more often as compared to the routinely assessed group of patients ( p < 0.01).…”

Section: Clinical Practice Implicationsmentioning

confidence: 99%

Right Heart Catheterization—Background, Physiological Basics, and Clinical Implications

Kubiak

Ciarka

Biniecka

et al. 2019

JCM

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The idea of right heart catheterization (RHC) grew in the milieu of modern thinking about the cardiovascular system, influenced by the experiments of William Harvey, which were inspired by the treatises of Greek philosophers like Aristotle and Gallen, who made significant contributions to the subject. RHC was first discovered in the eighteenth century by William Hale and was subsequently systematically improved by outstanding experiments in the field of physiology, led by Cournand and Dickinson Richards, which finally resulted in the implementation of pulmonary artery catheters (PAC) into clinical practice by Jeremy Swan and William Ganz in the early 1970s. Despite its premature euphoric reception, some further analysis seemed not to share the early enthusiasm as far as the safety and effectiveness issues were concerned. Nonetheless, RHC kept its significant role in the diagnosis, prognostic evaluation, and decision-making of pulmonary hypertension and heart failure patients. Its role in the treatment of end-stage heart failure seems not to be fully understood, although it is promising. PAC-guided optimization of the treatment of patients with ventricular assist devices and its beneficial introduction into clinical practice remains a challenge for the near future.

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Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

Cited by 57 publications

References 28 publications

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

Right Heart Catheterization—Background, Physiological Basics, and Clinical Implications

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