Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest

Karatolios, Konstantinos; Chatzis, Georgios; Markus, Birgit; Luesebrink, Ulrich; Ahrens, Holger; Dersch, Wolfgang; Betz, Susanne; Ploeger, Birgit; Boesl, Elisabeth; O’Neill, William W.; Kill, Clemens; Schieffer, Bernhard

doi:10.1016/j.resuscitation.2018.03.008

Cited by 42 publications

(33 citation statements)

References 23 publications

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“…The overall mortality in the study was 50% and there were no significant differences between the two arms (50% versus 46% at 30 days and 50% versus 50% at 6 months in the IABP and Impella CP groups, respectively), thus reflecting a very high risk cohort presenting with late-stage cardiogenic shock [6,73]. The only study reporting a mortality benefit of Impella in the setting of cardiogenic shock complicating AMI was by Karatolios et al [74], who conducted a retrospective, single-center study including 90 patients suffering from AMI and cardiogenic shock treated with Impella (n = 27) or medical treatment alone (n = 63). Patients in the Impella group were sicker, evidenced by higher lactate levels, longer low cardiac output duration, and lower LV ejection fraction than those treated medically.…”

Section: Clinical Benefit Of Percutaneous Mcs Devices For Pcimentioning

confidence: 99%

“…Patients in the Impella group were sicker, evidenced by higher lactate levels, longer low cardiac output duration, and lower LV ejection fraction than those treated medically. When 20 patients of each group were matched, patients supported with Impella had decreased rates of in-hospital (35% versus 80%; p = 0.01) and 6-month (40% versus 80%; p = 0.02) mortality [74]. More recently, using IABP-SHOCK II trial inclusion and exclusion criteria, a retrospective analysis of 237 patients with AMI and cardiogenic shock treated with Impella 2.5 (~30% of patients) or Impella CP (~70% of patients) were propensity matched to the same number of patients from the IABP-SHOCK II trial [75].…”

Section: Clinical Benefit Of Percutaneous Mcs Devices For Pcimentioning

confidence: 99%

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Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Asleh

Resar

2019

JCM

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Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.

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Section: Clinical Benefit Of Percutaneous Mcs Devices For Pcimentioning

confidence: 99%

Section: Clinical Benefit Of Percutaneous Mcs Devices For Pcimentioning

confidence: 99%

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Asleh

Resar

2019

JCM

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“…Daten aus Hannover zeigten, dass unter Nutzung der Impella die beobachtete Mortalität mit 24 % niedriger ist als in vergleichbaren Studienkollektiven (IABP-Shock = 49 %, CardShock = 36 %) [25]. In einer Analyse durch Paarbildung (propensity-matched analysis) hatten die mit Impella versorgten Patienten eine Überlebenswahrscheinlichkeit von rund 60 %, diejenigen ohne Impella nur von 20 % [26].…”

Section: Kur Zgefasstunclassified

Hypoperfusionssyndrom und kardiogener Schock

Hennersdorf

Scharpf

2019

Aktuel Kardiol

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ZusammenfassungDer kardiogene Schock stellt nach wie vor ein Krankheitsbild mit hoher Mortalität dar. In dieser Situation entwickelt sich nahezu regelhaft eine Laktatazidose durch Gewebsischämie. Diese wiederum unterstützt den klinischen Gesamteindruck eines Schockzustandes. Das erhöhte Laktat bzw. mehr noch die verzögerte oder fehlende Laktatclearance sind harte Prädiktoren der schlechten Prognose. In dieser Situation ist die hämodynamische Stabilisierung neben der Ursachentherapie oberstes Gebot. Eine balancierte Volumen-/Katecholamintherapie stellt die Basis dar. Früh muss aber eine Entscheidung für oder gegen den Einsatz eines mechanischen Unterstützungssystems fallen. Entscheidungshilfen sind klinische, aber auch laborchemische und interventionelle Faktoren. Das fallende Laktat (die Laktatclearance) ist auch unter extrakorporalem System der wichtigste Ausdruck einer funktionierenden Therapie. Randomisierte Studien, die eine Prognoseverbesserung dieser schwer kranken Patienten beweisen, existieren derzeit nicht. Umso wichtiger ist der rationale, aber frühe Einsatz dieser Systeme nach in Positionspapieren definierten Kriterien.

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“…Aus klinischen Untersuchungen wissen wir, dass mechanische Kreislaufunterstützungssysteme die Hämodynamik verbessern, und eine Regeneration des Myokards begünstigen können [2]. In der vorgestellten Studie haben Karatolios et al den Einfluss der Impella ® Herzpumpe, im Rahmen der Therapie des kardiogenen Schocks nach infarktbedingtem Herzkreislaufstillstand untersucht [3].…”

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“…Obwohl der Zustand der Impella® Patienten bei Aufnahme nachweislich schlechter war, konnte eine höhere Krankenhausentlassrate erzielt werden. Zudem war das Sechs-Monats-Überleben in der Interventionsgruppe signifikant höher als in der Kontrollgruppe [3].…”

unclassified

Herzstillstand nach Infarkt: bessere Ergebnisse mit mechanischer Kreislaufunterstützung

2018

JC AINS

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Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest

Cited by 42 publications

References 23 publications

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Hypoperfusionssyndrom und kardiogener Schock

Herzstillstand nach Infarkt: bessere Ergebnisse mit mechanischer Kreislaufunterstützung

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