Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock

Basir, Mir B.; Schreiber, Theodore; Grines, Cindy L.; Dixon, Simon; Moses, Jeffrey W.; Maini, Brijeshwar; Khandelwal, Akshay; Ohman, E. Magnus; O’Neill, William W.

doi:10.1016/j.amjcard.2016.11.037

Cited by 307 publications

(231 citation statements)

References 22 publications

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“…Despite the increasing use of MCS, there has been an unfortunate void in common practice patterns, which has resulted in tremendous variability in the use of MCS in AMICS . We have previously identified that delivery of MCS prior to PCI, prior to escalating doses of inotropes and within 1.25 hr from the onset of shock are associated with improved survival . Similarly, data from over 15,000 patients treated with Impella have shown that the use of invasive hemodynamics (i.e., right heart catheterization) and institutional volume is similarly associated with improved survival .…”

Section: Discussionmentioning

confidence: 99%

Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

Basir¹,

Kapur²,

Patel³

et al. 2019

Cathet Cardio Intervent

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370

311

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Background The National Cardiogenic Shock Initiative is a single‐arm, prospective, multicenter study to assess outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI). Methods Between July 2016 and February 2019, 35 sites participated and enrolled into the study. All centers agreed to treat patients with AMICS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those of the “SHOCK” trial with an additional exclusion criteria of intra‐aortic balloon pump counter‐pulsation prior to MCS. Results A total of 171 consecutive patients were enrolled. Patients had an average age of 63 years, 77% were male, and 68% were admitted with AMICS. About 83% of patients were on vasopressors or inotropes, 20% had a witnessed out of hospital cardiac arrest, 29% had in‐hospital cardiac arrest, and 10% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 74% of patients had MCS implanted prior to PCI. Right heart catheterization was performed in 92%. About 78% of patients presented with ST‐elevation myocardial infarction with average door to support times of 85 ± 63 min and door to balloon times of 87 ± 58 min. Survival to discharge was 72%. Creatinine ≥2, lactate >4, cardiac power output (CPO) <0.6 W, and age ≥ 70 years were predictors of mortality. Lactate and CPO measurements at 12–24 hr reliably predicted overall mortality postindex procedure. Conclusion In contemporary practice, use of a shock protocol emphasizing best practices is associated with improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

Basir¹,

Kapur²,

Patel³

et al. 2019

Cathet Cardio Intervent

Self Cite

370

311

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“…For CS, a similar quality metric that reflects the time between onset of CS and initiation of acute mechanical circulatory support (AMCS) should be developed as the “door to support” (DTS) time. Several recent reports support the concept of a DTS time and have observed improved survival with early initiation of AMCS before percutaneous coronary revascularization or before the initiation of inotropes and vasopressors in the setting of AMI-CS 9– 11 . Future studies quantifying the optimal DTS time in CS are required.…”

Section: The “Door To Support” Time In Cardiogenic Shockmentioning

confidence: 90%

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

Esposito

Kapur

2017

F1000Res

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Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction. CS begins as a hemodynamic problem with impaired cardiac output leading to reduced systemic perfusion, increased residual volume within the left and right ventricles, and increased cardiac filling pressures. A critical step towards the development of future algorithms is a clear understanding of the treatment objectives for CS. In this review, we introduce the “door to support” time as an emerging target of therapy to improve outcomes associated with CS, define four key treatment objectives in the management of CS, discuss the importance of early hemodynamic assessment and appropriate selection of acute mechanical circulatory support (AMCS) devices for CS, and introduce a classification scheme that identifies subtypes of CS based on cardiac filling pressures.

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“…These devices are a valuable tool in the management of CS due to their ability to maintain vital organ perfusion, decrease LV wall stress and myocardial oxygen consumption, thereby enhancing the likelihood of ventricular recovery . In fact, multiple studies have demonstrated that early initiation of Impella support within 90 minutes of CS onset was associated with higher survival . An additional advantage of early Impella use in CS is the decrease in the use of inotropic agents, thus, reducing the effects of these cardiotoxic drugs .…”

Section: Discussionmentioning

confidence: 99%

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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Background Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited. Objective To assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry. Methods and Results A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD). Conclusion MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.

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Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock

Cited by 307 publications

References 22 publications

Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

Acute mechanical circulatory support for cardiogenic shock: the “door to support” time

Use of Impella heart pump for management of women with peripartum cardiogenic shock

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