National Trends in the Utilization of Short-Term Mechanical Circulatory Support

Stretch, Robert; Sauer, Christopher M.; Yuh, David D.; Bonde, Pramod

doi:10.1016/j.jacc.2014.07.958

Cited by 421 publications

(260 citation statements)

References 14 publications

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“…1,6 In cardiac surgery units, ECMO is increasingly used as a bail-out strategy after cardiac surgery, including heart and lung transplantation. 8,9 Expansion in both the availability and application of ECMO may explain the progressive improvements in 30-day and 12-month outcomes observed between 2003 and 2014, despite the fact that patients later in the cohort were older with more comorbidities. Earlier placement of ECMO before circulatory or respiratory collapse complicated by multiorgan failure or need for prolonged cardiopulmonary resuscitation has been associated with improved early clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in New York State

Batra

Toyoda

Goldstone

et al. 2016

Circ: Heart Failure

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Background— Utilization of extracorporeal membrane oxygenation (ECMO) is expanding despite limited outcome data defining appropriate use. Methods and Results— To quantify determinants of early and 1-year survival after ECMO in adult patients, we conducted a retrospective cohort analysis of 1286 patients aged ≥18 years who underwent ECMO in New York State from 2003 to 2014. Median follow-up time was 4.9 months (range, 0–12 months). ECMO utilization increased from 13 patients in 8 hospitals in 2003 to 330 patients in 30 hospitals in 2014. Compared with patients undergoing ECMO before 2009, later patients were older (54.4 versus 52.3 years; P =0.013) and more likely to have major comorbidity including chronic kidney disease (25.2% versus 13.2%; P =0.02) and liver disease (20.0% versus 10.7%; P =0.001). In the overall cohort, 30-day mortality was 52.2% (95% confidence interval, 49.5–54.9). Mortality at 30 days was 65.2% for patients aged ≥75 years (n=73/112) and 74.6% in patients who required cardiopulmonary resuscitation (n=91/122). Survival at 1 year was 38.4% (95% confidence interval, 35.7–41.0). The 30-day mortality and 1-year survival improved across the study period. In multivariable analysis, earlier year of ECMO, lower hospital volume, indication for ECMO after a cardiac procedure, cardiopulmonary resuscitation before ECMO placement, and age >65 years were independent predictors of worse survival. Conclusions— Outcomes of ECMO have improved despite increasing comorbidity. Extreme mortality after ECMO in elderly patients and patients requiring cardiopulmonary resuscitation indicates that less invasive therapeutic or palliative modalities may be more appropriate in this end-of-life setting.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in New York State

Batra

Toyoda

Goldstone

et al. 2016

Circ: Heart Failure

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“…We currently attempt to get at this information indirectly such as analyzing the use of short-term mechanical support circulatory devices from national databases such as the National Cardiovascular Data registry Cath PCI Registry or the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, which however are not designed to provide much guidance about highrisk PCI. [8][9][10] Similar to our experience with percutaneous valve therapies, high-risk PCI involves a multidisciplinary team approach. Many of the patients sent to our practice are turned down for coronary artery bypass grafting or repeat coronary artery bypass grafting by cardiac surgeons.…”

Section: Challengesmentioning

confidence: 95%

High-Risk Percutaneous Coronary Interventions in Modern Day Clinical Practice

Bass

2015

Circ: Cardiovascular Interventions

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A t its inception, all percutaneous coronary interventions (PCI) were considered high risk. The initial US experience published by the National Heart, Lung, and Blood Institute Registry reported procedural success to be <60% and the need for emergent coronary bypass surgery occurring 6% of the time.1 It was mandatory to have a cardiothoracic surgeon immediately available and an operating room open and ready to go. These outcomes involving a far less complex, lower risk population compared with patients we currently treat would be completely unacceptable today. The evolution of coronary interventions has been remarkable during the past decades attributable to the refinement and development of new device technologies, imaging capabilities, adjunctive pharmacotherapies and the explosive growth in physician and catheterization laboratory team experience. This has resulted in a greatly expanded population who can now be treated by PCI, including sicker patients often with more complex anatomic lesions. Overall reported procedural success rates are now expected to approach 100% and complication rates continue to trend toward or <1%. With this history and in our current environment of expanding databases, public reporting, cost-sensitive resource use, and increased patient expectations, the concept and reality of high-risk PCI continues to evolve.First and foremost, it is helpful to differentiate complex PCI from high-risk PCI. The interventional cardiovascular community has spent a great deal of effort defining, classifying, and attempting to understand how to best treat patients presenting for complex PCI. The term complex PCI is a descriptor applied to patients presenting with complex, anatomic coronary lesions. These lesions may have a variety of defining characteristics such as severe calcification, extensive thrombotic burden, extreme tortuosity or length, or might be chronically, totally occluded. The lesion location might be located at a coronary bifurcation or in a degenerated saphenous venous bypass graft. Analysis derived from large registries have consistently demonstrated that PCI involving these anatomically complex lesions results in expected lower procedural success rates with an increased risk of procedural complications when compared with PCI of less anatomically complex coronary lesions. 2 We have successfully developed both the technology and interventional techniques to facilitate optimally treating these lesions.An example of a complex PCI might be a middle-aged male with normal left ventricular (LV) function and increasing angina presenting for PCI with a heavily calcified bifurcation lesion involving the left anterior descending-first diagonal bifurcation. This is indeed different from what should be considered as a high-risk PCI, which might involve the same angiographic lesion, but occurring in an elderly male with a chronically occluded right coronary artery and a severely decreased LV ejection fraction. Therefore, the approach, skill sets, and support systems required to do these interventi...

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“…Despite the lack of data derived from randomized clinical trials on the efficacy, safety and differential indications for different devices, percutaneous mechanical support with active devices is increasingly being performed 45 .…”

Section: Mechanical Supportmentioning

confidence: 99%

Pulmonary Hypertension in A Patient with Systemic Sclerosis

S.T¹,

Ezennaka²

2017

IOSR JDMS

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INTRODUCTION:Cardiogenic shock (CS) is defined as a state of critical end organ hypoperfusion due to reduced cardiac output.The most frequent cause is acute myocardial infarction (AMI) with subsequent ventricular dysfunction in about 80% of cases. In spite of the advances made in the treatment of AMI, cardiogenic shock remains a leading cause of death with mortality rates approaching 40-50%. AIM: The purpose of this review is to highlight the current concepts in the management of cardiogenic shock. MATERIALS AND METHODS: A systematic review of published literature using PubMed and Med Line was done using search items like "cardiogenic and shock". Secondary references obtained from this publication were identified by manual search and reviewed as relevant. RESULTS: Cardiogenic shock is characterized by inadequate tissue perfusion in the setting of adequate intravascular volume. The treatment involves general supportive measures which include; adequate oxygenation and ventilation, correction of electrolytes and acid-base abnormalities, pain reliefand restoration of sinus rhythm. Revascularizationand mechanical supports are also necessary. CONCLUSION:The diagnosis and management of cardiogenic shock are difficult and require extensive knowledge and clinical experience. In spite of the significant advances made, the management still remains a challenge.

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National Trends in the Utilization of Short-Term Mechanical Circulatory Support

Abstract: Use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS.

Cited by 421 publications

References 14 publications

Extracorporeal Membrane Oxygenation in New York State

Extracorporeal Membrane Oxygenation in New York State

High-Risk Percutaneous Coronary Interventions in Modern Day Clinical Practice

Pulmonary Hypertension in A Patient with Systemic Sclerosis

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